Provider Resolution Analyst

Job Summary

A company is looking for a Provider Resolution Analyst I.

Key Responsibilities:

• Investigate and analyze complex claim issues, coordinating resolution across multiple operational areas
• Conduct research and follow-up on paper and electronic claims disputes, escalating complex issues as necessary
• Identify resolutions and create tracking requests for systemic changes, supporting the department and customer service

Required Qualifications, Training, and Education:

• High School Diploma/GED required
• 2+ years of claims experience required
• Facets experience preferred; other claims experience considered
• Knowledge of CPT/HCPC and ICD9 coding procedures and guidelines
• Knowledge of Medicaid or other Governmental Health Programs preferred