Senior Claims Specialist
Current- Claims Analysis: Lead the comprehensive review, analysis, and evaluation of complex healthcare claims to ensure accuracy and compliance with policy provisions and regulatory requirements.
- Contractual Review: Analyze contractual agreements to determine the financial obligations and verify adherence to payment terms.
- Overpayment Resolution: Drive the resolution of overpayments by utilizing in-depth investigations and identification processes based on relevant claims information, policies, and regulations.
- Provider Interaction: Address concerns, inquiries, and appeals from healthcare providers regarding claims, demonstrating a thorough understanding of medical billing and reimbursement processes.
- Quality Assurance: Establish and implement quality assurance measures to enhance claims processing accuracy and efficiency.
- Policy Adherence: Ensure strict adherence to internal policies, external regulations, and industry best practices.