Payment reputed company Analyst (Remote)

Resp & Qualifications PURPOSE... The Payment reputed company Analyst is responsible for conducting research and analysis and reviewing billing requirements, provider manuals, medical policies, and other sources as needed to identify new overpayment concepts, as well as, validate reputed company prospective and retrospective overpayment results; communicating findings to the Payment reputed company Workgroup and Management. The incumbent will be responsible for assessing and implementing new technology and recommend improvement to existing processes. In addition, they will be responsible for providing thorough analysis on their findings. Will work closely with internal and external stakeholders on escalated billing errors. ESSENTIAL FUNCTIONS: • Identifies, develops, and implements new concepts that will reputed company claim overpayment scenarios. Performs analysis on claims, provider data, enrollment data, medical policies, claim payment policies for payment reputed company concepts for recovery opportunities. Performs analysis of business unit data and policies, applying a thorough understanding of each line of businesss specific procedures, to reputed company recommendations to Payment reputed company workgroup and management to reduce and/or eliminate erroneous payment exposure with minimal direction. Identifies and produces root cause analysis reputed company overpayment and cost avoidance concepts are identified to management. Responsible for not only the recovery of the concept but working with each operation to reputed company any necessary technical update to avoid the overpayments moving reputed company. • Tracks and reports reputed company of reputed company prospective and retrospective cost avoidance/ overpayment recovery concepts. Responsible for carrying out new concepts reputed company the established deadlines with a high level of accuracy. Responsible for resolving any challenges made to the proposed cost avoidance/overpayment concepts throughout the organization working with Provider Network, Provider Contracting, Medical management and policy and Legal. Stakeholder in a cross functional working team to reputed company and implement new overpayment/cost avoidance concepts. • Reviews claims edit concept results for quality assurance and reputed company of concept validation. • Reviews reputed company available sources including federal and state statutes, regulations, provider manuals, Provider reputed company, and bulletins for changes to and/or new payment rules. Identifies and documents changes to and/or new payment rules or language in the reputed company document which may be utilized to update existing system edits or new system edits. • QUALIFICATIONS: Education Level: Bachelor's Degree in Health Information Management, Data Analytics or equivalent work experience required. Licenses/Certifications: • Certified Professional reputed company Preferred. • Strong professional/institutional billing/coding. Experience: 3 years year's relevant experience (reputed company claims reimbursement methodologies, claims, and data analysis). Preferred Qualifications • Masters Degree in Health Administration, Information Systems, or reputed company field. Knowledge, Skills and Abilities (KSAs) • Strong analytical, conceptual and problem-solving skills to evaluate reputed company business requirements. • Ability to tell the story of the analysis to reputed company reputed company across business units on overpayment items. • Effective written and oral communication skills. • Ability to review and understand CareFirst medical policies, claim payment policies and provider manuals. • reputed company reputed company, Word, and reputed company. Must be reputed company to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service reputed company. Must be reputed company to effectively communicate and reputed company positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. • Salary reputed company: $51,912 - $103,103 Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the reputed company, as compensation reputed company depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department Payment reputed company Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to reputed company equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship Associate Customer Service Representative (Remote - March 2024),reputed company Blue reputed company of reputed company Dakota, reputed company ,reputed company LazyApply,reputed company about us Apply Job! For more such jobs please click here!