Provider Reimbursement Specialist
Provider Reimbursement Specialist
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Job Details
Description
Centurion is proud to be a leading provider of comprehensive healthcare services to correctional facilities state hospitals and community mental health centers nationwide.
We are currently seeking afull-time Provider Reimbursement Specialist tojoin ourCorporate Team.
The Provider Reimbursement Specialist maintains relationships with physicians hospitals ancillary providers and Health Nets internal Provider Network Management Dept. Acts as first line contact for providers/hospitals on claims projects and other non-routine claim issues. Oversees in conjunction with the Adjustment and New Day Unit Supervisors resolution of project issues and is responsible to communicate final resolution to the provider/hospital or other business units and/or managers as needed and/or as required. Assists with policy and procedure interpretation. Researches analyzes and resolves complex problems with claims development and finalization
Qualifications
- Assists with complex claim issues and acts as the first line contact for providers on large projects and non
- routine claim issues.
- Manages projects in conjunction with assigned adjusters and/or regional units for research analysis and resolution. Responds directly to the providers with final resolution of the issues up to and including: root cause documentation/feedback necessary corrective action plans and/or process improvement initiatives.
- Conducts routine periodic site visits to providers/physicians/facilities. Participates with Network Management in Joint Operating Committee (JOCs).
- Coordinates with Provider Network and Provider Data Management for contract data corrections. Identifies and reports to Provider Network Management contracting opportunities with problematic provider contracts based on root cause analysis.
- Interprets Health Nets Policy and Procedures as it relates to claim issues providing interpretation and clarification on contracts and benefits. Coordinates with Provider Network Management (PNM) if unable to resolve with provider and internal departments.
- Participates in process improvement activities working directly with the process improvement team to report root causes and facilitates corrective actions as needed.
- Prepares monthly reports to management to document issues action plans and resolutions of quality initiatives and provider relation improvement initiatives. Researches and responds to Shared Risk Discrepancies from Participating Provider Groups.
We offer excellent compensation and comprehensive benefits for our full-time team members including:
- Health dental vision disability and life insurance
- 401(k) with company match
- Generous paid time off
- Paid holidays
- Flexible Spending Account
- Continuing Education benefits
- Much more...
Required Experience:
Unclear Seniority
Employment Type
Full-Time
