Evan Smith Email & Phone Number

Lowell, Mi, Us

Grand Rapids, Mi, Us

Performs routine inspection of transactions in a statistically valid manner, following industry practice for identifying aberrancies in processing that are out of accordance with corporate policy or contract conditionsIdentify training opportunities and system root causes that will result in improved performance. Develops procedure and process updates based on audit data. Explains issues (problems or errors) that may arise in the department and communicate updates needed in the procedures to reflect current informationConfers with trainers and leadership to gain knowledge of work situations requiring training for employees to better understand changes in policies, procedures as well as changes in the Certificate of Coverage and Schedule of Benefits for various plans

Grand Rapids, Mi, Us

This position is responsible for identification of operational quality audit error criteria not included in current audits and within the scope of the operational quality audit team. This responsibility is accomplished through reviewing audit samples beyond the current auditing criteria to identify any quality concerns our current audits would not evaluate. When determined warranted findings are documented and evaluated to determine if they should be added to existing audits and what actions should be taken.Executes monthly auditing functions to defined procedures following standard documentation. Maintains, improves and adds to auditing procedures. Seeks out industry and organizational knowledge to validate auditing samples and identify quality concerns. Creates analysis of quality concerns. Supports special projects and other auditing functions. Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.

Grand Rapids, Mi, Us

Performs audits according to department policies and procedures. Maintains and utilizes tools needed to track, trend and report audit results per department policy and procedure. Record results in an accurate and organized manner for the purpose of reporting individual and departmental results. Able to collaborate and explain/demonstrate the findings through the audit. Looks for opportunities to learn from more experienced Business Systems Analysts.Confers with Quality staff and trainers to gain knowledge of work situations requiring training for employees to better understand changes in policies, procedures as well as changes in the Certificate of Coverage and Schedule of Benefits for various plans. May initiate procedure changes. Works under close supervision within established policies, practices and guidelines. Actively seeks to keep informed and updated on all software systems. Participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.

Us

The BCNA Liaison is responsible for the adjudication of medical and hospital claims at all pend levels, manual pricing using external pricers, addressing inquiries received from other departments, adjustment of previously paid or denied medical and hospital claims, processing checks received from providers, in accordance with CMS and other relevant regulations and corporate policies.

Us

SIU Claims Liaison is responsible for the adjudication of medical and hospital claims at all pend levels, including investigation, resolution, and timely response to provider, member or group inquiries related to claims. These inquiries may be received from Provider Affairs, Field Services, Customer Services, PFA, other claims teams or other areas at BCN and may be communicated via Contact Service Forms, oral and written correspondence or report requests. Resolving the inquiries or the requests may require contacting and interacting with individuals in other departments or with providers directly to understand the issue, to address root cause problems and to educate providers on appropriate processes and procedures to follow to enable claims to be processed correctly.

Us

Responsible for the resolution of pended claims in an accurate and timely manner as indicated by the corporate standard on accuracy and production standards. Responsible for the completion of any claims processed on the on-line environment to a finalized status. Responsible for resolution of system Batch Errors. Perform other reasonably related duties, including special projects as assigned by immediate supervisor and other management staff as required.

Bachelor Of Arts - Ba, Music Business

Associate Of Arts - Aa, Liberal Arts And Sciences, General Studies And Humanities