Job Description:
Provider Pay Reconsider Analyst I
Location: Must live within 50 miles of the Mason, OH, Norfolk, VA, Roanoke, VA, Miami, FL, or Madison, WI PulsePoints.
The Provider Pay Reconsider Analyst I 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 HS 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:
- 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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