Job Description
The Provider Network Ops Analyst is responsible for:
+ Claims resolution: working with EO, providers and Provider Network Management.
+ Informal provider disputes– intake, investigation, resolution.
+ Member grievances (related to billing) via Contact Center/EO, Compliance, etc.
+ Submission/audit of any necessary OLH updates to Knowledge Management.
+ Intake/workflow tool management.
+ DME/other manual pricing/invoice intake, development, ownership.
+ Participate in credit balance inquiries and investigations.
**Education/ Experience:**
+ High School Diploma/GED required.
+ Associate’s Degree or equivalent combination of education and work experience preferred
+ 3 to 5 years claims experience, as well as experience in healthcare, managed care or insurance industry environment. Provider data experience preferred.
+ 1 to 3 Healthcare claims processing experience required.
+ Facets software experience preferred.
+ Proficiency wi...
+ Claims resolution: working with EO, providers and Provider Network Management.
+ Informal provider disputes– intake, investigation, resolution.
+ Member grievances (related to billing) via Contact Center/EO, Compliance, etc.
+ Submission/audit of any necessary OLH updates to Knowledge Management.
+ Intake/workflow tool management.
+ DME/other manual pricing/invoice intake, development, ownership.
+ Participate in credit balance inquiries and investigations.
**Education/ Experience:**
+ High School Diploma/GED required.
+ Associate’s Degree or equivalent combination of education and work experience preferred
+ 3 to 5 years claims experience, as well as experience in healthcare, managed care or insurance industry environment. Provider data experience preferred.
+ 1 to 3 Healthcare claims processing experience required.
+ Facets software experience preferred.
+ Proficiency wi...
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