Provider Payment Reconsider Analyst I
Must be located within 50 miles of Tampa, FL, Norfolk, VA, Mason, Ohio or Des Moines, IA.
This position supports the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Reconsideration requests.
How you will make an impact:
Reviews and analyzes provider requests to investigate the outcome of claim payment or denial.
Determines the appropriate resolution using strict adherence to internal guidelines, policies, and procedures.
Must work with various departments, when necessary, to determine root cause and appropriate resolution.
Must remediate impacted claims.
Minimum Requirements:
Requires a high school diploma or GED and a minimum of 3 years experience working in claims or customer service; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Prior claims processing experience and claims platform experience strongly preferred.
Familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of claims process, and the company's internal business processes and technologies preferred.
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