Support the Payment Dispute process across all lines of business and resolve Provider Payment Appeal requests
Review and analyze provider requests to investigate the outcome of a Reconsideration
Consider all information when determining whether to uphold or overturn primary decision
Work with various departments including Provider Solutions and Health Plan Operations leadership to determine root cause and appropriate resolution
Work with Claims Operations to remediate impacted claims
Virtual role with required in-person training sessions and potential hybrid onsite requirements per company policy
Requirements
HS diploma or GED
Minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
or any combination of education and experience which would provide an equivalent background
Bachelor's degree preferred
Claims processing experience preferred
WGS/CI&W experience preferred
Must be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law
Candidates in certain patient/member-facing roles required to become vaccinated against COVID-19 and Influenza (offer rescinded if not vaccinated unless acceptable explanation)
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