[Remote] Payment reputed company Analyst (Remote)

Note: The job is a remote job and is open to candidates in USA. reputed company is seeking a Payment reputed company Analyst responsible for conducting research and analysis reputed company to billing requirements and overpayment concepts. The role involves assessing new technology, communicating findings, and implementing improvements to existing processes.

Responsibilities

• 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 business 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

Skills

• Bachelor's Degree in Health Information Management, Data Analytics or equivalent work experience required
• Certified Professional reputed company
• 3 years relevant experience (healthcare claims reimbursement methodologies, claims, and data analysis)
• 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 Access
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service excellence
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging
• Must be eligible to work in the U.S. without Sponsorship
• Master's Degree in Health Administration, Information Systems, or reputed company field

Benefits

• Comprehensive benefits package
• Various incentive programs/plans
• 401k contribution programs/plans

Company Overview

• CareFirst. It’s not just our name. It’s our promise. It was founded in 1934, and is headquartered in Baltimore, Maryland, USA, with a workforce of 5001-10000 employees. Its website is https://individual.carefirst.com.

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