Description

Description Strength Through Diversity Ground breaking science. Advancing medicine. Healing made personal. Roles & Responsibilities: The Health Plan Claims Analyst I is responsible for multiple components of specific health plan operations. He/she is responsible for providing administrative, operational and programmatic support services of within an assigned area/department. This position requires strong problem solving skills, analytical and organizational abilities, and involves making recommendations to program leadership for quality improvement. The position will also require coordination of workflow across multiple entities including payors, providers, and program leadership and therefore also requires effective communication Responsibilities Responsible for assisting in the provider network enrollment process. Responsible for maintaining and following up with all provider network agreements (PNA). Which includes communicating with patient care teams and claims team about status of PNA. Responsible for collecting and coordinating NIOSH medical document requests. This includes reaching out to providers for additional medical records. Receives and follows up with patient bills as needed when providing staff coverage. ...