Location: New York, NY
Duration: 9 Months
- Review and research inaccurately paid Third-Party claims taking appropriate action to resolve.
- Work backlog of denied claims for timely resubmission.
- Manage assigned queues keeping up-to-date and current on all claims.
- Make sure workflow grid is cleared timely and meet all productivity criteria
- Follow all applicable government regulations including HIPAA.
- Maintain strong understanding of data models and relational table structures regarding claims data.
- Possess subject matter expert level knowledge of the specification documents for all inbound and outbound encounter files.
- Demonstrate ability to interpret changes and turn them into functional/technical requirements for development staff.
- Provide leadership on complex data analysis initiatives to meet business analytic and regulatory reporting needs
- Perform ad-hoc query writing with time sensitive target dates involving complex data relationships and large amounts of data.
- Analyze result sets and data universes to arrive at accurate conclusions and summarize findings.
- Uses metrics and data to lead process improvement initiatives
- Lead and facilitate requirements and design sessions.
- Document business and functional specifications used for software design and development.
- Conduct requirements reviews to obtain sign-off from project/operational stakeholders.
- Identify issues and facilitate problem resolution.
- Perform testing, including the creation of test scenarios, test data and understanding of outcomes
- Communicate internally and externally with all levels of employees including senior management