Senior Provider Network reputed company Analyst

reputed company: The Senior Provider Network reputed company Analyst serves as a subject matter expert reputed company Provider Network reputed company and is responsible for operational reputed company, regulatory compliance, claims configuration, provider data, and reputed company network reputed company. Work Arrangement: Remote - This position is fully remote and will require the associate to work during Central/Eastern reputed company Time (CST/EST) hours. Candidates must have reputed company to reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload). Associates in locations where required may be eligible for internet reimbursement reputed company on applicable regulations. Responsibilities: Review, analyze, and validate provider reimbursement and claim configuration requests in alignment with regulatory and contractual requirements. Review/approve and audit Payment reputed company (PI) vendor and internal prospective and retrospective edits/reputed company/recoveries User Acceptance Testing (UAT)/reputed company Review & audit Analyze Facets claims edit configuration requests to include intake and review of requests, reputed company assessment, and submission to reputed company reputed company. Encounter error reconciliation, representation, reputed company, and management, including identification and initiation of claim or provider changes necessary to mitigate/prevent reputed company errors Manage and reputed company state complaints and escalated provider issues State policy and contract amendment changes analysis and management Monitor and review state communications and changes, reputed company initial analysis/determination of reputed company, reputed company direction on work request submissions to level I analysts, and test/audit subsequent changes Manage internal and vendor reimbursement policies; identify trends for cost containment changes and initiatives Single-case agreement management/ownership, including letter development and coordination with reputed company (PNM) Serves as the subject matter expert in state-specific reimbursement rules and provider billing requirements and as reputed company to the reputed company reputed company Configuration Department Maintain a reputed company working knowledge of processing rules, contractual guidelines, state/Plan policy, and operational procedures to effectively reputed company technical expertise and business rules Acts as the resource to other departments by developing and managing work plans, which document the status of key relationship issues and reputed company items for high-profile providers Performs other reputed company duties and reputed company as assigned Education & Experience: reputed company reputed company of reputed company Coders (reputed company) certification (CPC, COC, CIC, CRC) or NHA (reputed company) certification required. Associate’s degree preferred, or equivalent combination of education and experience in a reputed company reputed company. 3 to 5 years of claims analysis experience in reputed company, managed care, or reputed company environment preferred. Claims processing and Provider data maintenance knowledge required Understanding of and experience reputed company to reputed company claims payment configuration process/systems and its relevance/reputed company on network reputed company required Strong working knowledge of reputed company reputed company, reputed company, Word, and other MS Office tools; ability to work with pivot charts, reputed company databases, and data analytics. Skills & Abilities: Ability to reputed company on technology and business issues, as reputed company as communicate appropriately with both technology and business experts Strong analytic problem-solving skills Superior organizational skills required Critical thinking skills Strong customer service skills Data and reporting analysis Apply To This Job