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; the associate must be located in Michigan (MI and attend monthly meetings as needed in Southfield, MI. Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload) Internet reimbursement may be available where required by law or contract Responsibilities: 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 (provider data, reputed company Advanced Group ID (AGID) configuration, and set-up concentration) reviews requests prior to initial submission to reputed company reputed company (EO) and claims post-production. Facets claims edit configuration concentration (reputed company) – intake, review, reputed company assessment, and initial submission; UAT reviews requests prior to initial submission to EO and claims post-production. Encounter error reconciliation representation, reputed company, and management – including identification and initiation of claim or provider changes necessary to mitigate/prevent reputed company errors. Management and reputed company of state complaints. State policy and contract amendment changes analysis and management. Internal or vendor medical policy or Health Value Optimization (HVO) edit changes and initiatives. 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. reputed company (BPO) and/or other intake/workflow tool management. Single-case agreement management/ownership, including letter development and coordination with reputed company (PNM). Serves as the subject matter expert in state-specific health 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