Responsible for assisting in the identification, development and coordination of strategic relationships with payors and organizations that influence payor decision-making. Continuous monitoring of federal, state, and payor policies that impact reimbursement of supported services. Execute ongoing and ad-hoc reporting requests and other project assignments issued by Revenue Cycle and Payor Relations Management. Responsible for continuous system and data integrity maintenance to ensure Leadership can be confident in data driven decision making. Completing transactional case work on a day-to-day basis, with a focus on training and quality assurance of Tier 1 case workers, and review and delivery of guidance for Tier 2 issues.
EDUCATION & EXPERIENCE:
Bachelor’s degree or five (5) to seven (7) equivalent work experience.
BACKGROUND & EXPERTISE:
At least three (3) years experience in a healthcare and/or health insurance related environment.
Health insurance claim submission and appeals process, with an emphasis on denial and recoupment resolution efforts.
Advanced level competence with MS office (Outlook, Excel, Word, OneNote). Customer Relationship Management (CRM) system experience is preferred.
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