Claims Resolution Analyst

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Responsible for researching inquiries received via Payor, correspondence, e-mail or escalation from upper management pertaining to denied, rejected or underpaid claims for services rendered by participating and non-participating independent physicians, groups, vendors and ancillaries for EP Lines of Business.

• High School Diploma, or equivalent, required; bachelor's degree, preferred.
• With bachelor's degree; minimum of one year of experience in Managed Care, provider billing, and/or customer service. Without bachelor's degree, minimum of three (3) years of experience, as above.
• Knowledge of Microsoft and Excel.
• Knowledge of ICD 10 and CPT4 coding and medical terminology.
• Knowledge of coordination of benefits regulations.
• Knowledge of various payment methodologies, i.e. DRG, APC, etc.
• Ability to multi-task, work in a fast-paced environment and with minimal supervision.
• Ability to develop and maintain client relationships.
• Strong communication skills, both written and oral.