2 or more years of progressively responsible experience in a managed care or healthcare environment is preferred.
Experience with ICD-10, CPT/HCPCS Codes
Experience with Medicare and Medicaid Reimbursement Methodologies
Job Summary/Description:
Acts as the primary liaison between Provider Relations Consultants and internal Plan departments such as Claims, Benefits, Audit, Member and Provider Enrollment and Clinical Services to effectively identify and resolve claim issues.
Works closely with the leadership team to identify issues and report trends.
Qualifications/Skills:
Education: Bachelor's degree in Business Administration, related field or an equivalent combination of education, training and experience is required.
2 or more years of progressively responsible experience in a managed care or healthcare environment is preferred.
Experience with Medicare and Medicaid Reimbursement Methodologies.
Understanding of provider coding and billing practices.
Experience with ICD-10, CPT/HCPCS Codes, and billing claim forms.
Ability to work as a team member, to manage multiple tasks, to be flexible, and to work independently and possess excellent organizational skills.
Proven expertise utilizing Microsoft Office products.
Effective communication skills (verbal and written).
Strong follow-up skills.
Proficient in multi-tasking.
Ability to set and manage priorities.
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