Provider Reimbursement Specialist
Current• Responsible for maintaining internal and external relationships with my region’s physicians, hospitals, ancillary providers and Health Net’s Provider Network Management Dept and acting as first line contact for my region’s claims-related projects and issues. • Responsible for researching and performing root cause analysis on my assigned claims-related projects and issues; then managing the resolution of the issue and communicating the resolution back to the internal and external customer upon completion. • Provide proactive analysis of claims-related issues to identify incorrect processing trends and communicating and educating examiners and auditors on correct processing.