Reimbursement Analyst
3 weeks ago
**Key Responsibilities:**
* Investigate and resolve high-level claims-related issues
* Conduct audits to review accuracy of cost reports and payment of claims
* Provide timely resolution of issues to improve engagement between the Plan and Hospital Network, Ancillary, and Community providers
* Review inquiries from providers regarding cost report settlements
* Research and analyze claim processing outcomes
* Prepare and analyze cost/business proposals and reports of findings
**Requirements:**
* Bachelor's degree
* 3-5 years experience in a managed care government program claims processing/analyzing experience, working with providers in addressing reimbursement issues
* Or an Associate Degree with 5-7 years or more experience in a managed care government program claims processing/analyzing experience, working with providers in addressing reimbursement issues
* Ability to work independently to meet deadlines
* Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint, Sharepoint
* Ability to exercise tact and diplomacy and demonstrate strong customer service skills
* Ability to prepare written and oral reports and make effective presentations
* Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation
* Highly organized, detail oriented, dependable and professional individual
* Ability to travel to meet with Providers and their representatives
**Professional Competencies:**
* Integrity and Trust
* Customer Focus
* Functional/Technical skills
* Written/Oral Communication
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