Remote Provider Reimbursement & Fee Schedules Specialist

Fidelis Care - New York; New Jersey; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off and holidays

Flexible remote/hybrid work schedules

Job summary

Centene is seeking a provider claims analyst to maintain relationships with physicians and hospitals, acting as the first line contact on claims projects and non-routine issues. The role involves coordination with the Provider Network Management Department and research to resolve complex claim problems.

The position requires a Bachelor’s degree in Health Services and at least two years of claims review/appeal experience, with preference for candidates in the NY/NJ/CT/PA tri-state area.

Qualifications

• Bachelor’s degree in Health Services, Health Care/Hospital Administration or related field.
• Minimum of two years experience in medical claims review and/or claims appeal.

Responsibilities

• Assist with complex claim issues; first line contact for providers on large projects and non-routine claim issues.
• Manage projects with assigned adjusters/regions for research, analysis and resolution.
• Respond to providers with final resolution, including root cause documentation and corrective action plans.
• Conduct routine site visits to providers, physicians and facilities.
• Coordinate with Provider Network Management for contract data corrections.
• Identify and report contracting opportunities with problematic provider contracts.

Skills

Medical claims review

Claims appeal

Education

Bachelor’s degree in Health Services

Job description

Centene is seeking a provider claims analyst to maintain relationships with physicians and hospitals, acting as the first line contact on claims projects and non-routine issues. The role involves coordination with the Provider Network Management Department and research to resolve complex claim problems.

The position requires a Bachelor’s degree in Health Services and at least two years of claims review/appeal experience, with preference for candidates in the NY/NJ/CT/PA tri-state area.