Offer summary

Qualifications:

Bachelor’s degree or equivalent work experience (5-7 years), At least 3 years of experience in healthcare or health insurance, Knowledge of health insurance claim submission and appeals process, Advanced proficiency in MS Office and CRM systems preferred..

Key responsabilities:

Assist in developing strategic relationships with payors

Monitor federal, state, and payor policies affecting reimbursement

Execute ongoing and ad-hoc reporting requests

Train and ensure quality assurance for Tier 1 case workers.

Job description

JOB DESCRIPTION:

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.

ESSENTIAL FUNCTIONS:

· Demonstrates intimate knowledge of UAS processes to proficiently train and QA Tier 1 case workers and offer guidance for Tier 2 health insurance claim and payor issues.

· Monitors federal, state, and payor policies that impact reimbursement of supported services.

· Maintains system and data integrity via continuous monitoring and analysis of user inputs.

· Executes ongoing and ad-hoc reporting requests.

· Assists with the identification, development and coordination of strategic relationships with payors and organizations that influence payor decision-making

· Performs other related duties and projects as required or assigned.

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.

APPLICABLE EXPERIENCE:

Health insurance claim submission and appeals process, with an emphasis on denial and recoupment resolution efforts.

COMPUTER LITERACY:

Advanced level competence with MS office (Outlook, Excel, Word, OneNote). Customer Relationship Management (CRM) system experience is preferred.

Required profile