Employer Industry: Healthcare Management

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on claims processing and operational efficiency
- Strong emphasis on analytical skills and problem-solving
- Engage in regular meetings with provider groups, enhancing communication and teamwork

What to Expect (Job Responsibilities):
- Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review
- Maintain and organize detailed information on claims dispute files to ensure timely data return to providers
- Track issues and monitor trends to support their resolution
- Identify potential/actual claims problems and document root cause analysis; present findings to management
- Conduct regular meetings with assigned provider groups regarding the status of accounts receivable files

What is Required (Qualifications):
- Bachelor's Degree
- 2 - 3 years' prior related work experience in a professional/facility claims or benefits/billing environment
- Strong knowledge of claim processing policies and procedures
- Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement, and EDP testing procedures
- Proficiency with MS Office applications

How to Stand Out (Preferred Qualifications):
- Additional experience or specialized training may be considered in lieu of educational requirements
- Ability to accurately interpret information from contractual and technical perspectives
- Conscientious and detail-oriented with the ability to recognize unusual patterns
- Strong analytical and problem-solving skills
- Ability to effectively absorb and communicate information

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