Provider Experience Analyst

The Analyst performs trending and analysis to support the provider service team with identifying trends and patterns that impact a provider’s cash flow. Analyst works to complete research and resolve provider service issues related to claim payments to improve their outstanding A/R and to provide consistent payment patterns. This activity includes researching claim rejections and denials, portal connectivity issues, educate and communicate policy and process changes. The quality and execution of the Analysts’ work is critical to the success of the Provider Services.

In this role, you will:

• Conduct claims research to identify patterns and trends that cause a disruption to timely and accurate payment of claims.
• Perform analyses to assess provider trends, process gaps and opportunities and to improve the overall provider experience.
• Proactively develop and manages provider relationships.
• Seek to improve the provider experience through effective research and resolution to provider issues and concerns.
• Participate actively to support or lead projects and tactical initiatives.
• Collaborate and work well within both the Provider Service team and across other departments.
• Collaborate with team members to derive trends, conclusions and recommendations based on the data and analyses.
• Manage multiple tasks and projects, is detail oriented, responsive, and demonstrates independent thought and critical thinking.
• Provide Provider Training on Policy and Process changes and other communications as necessary
• Research, resolve and track provider complaints.
• Facilitate and participate in Provider Town Hall and onsite meetings as needed.
• Perform analysis to assess claims processing trends, systems and business process gaps and recommend opportunities to improve the claims life-cycle process
• Support current client support for CareCentrix core (durable medical equipment, home infusion therapy, sleep management and traditional home health product offerings) from a claims analysis, issue identification and resolution
• Support current and future business implementations that will require Medicare, Medicare Advantage and/or Medicaid lines of business

You should reach out if you have:

• Bachelor's Degree preferred, or equivalent years of experience, with a business or IT concentration preferred. 
• Health insurance industry experience required with a minimum of 1-2 years of experience in local and BlueCard claims, medical coding, analytics, or provider service operations.
• Knowledge of claim payment processes and systems is preferred.
• Strong written and verbal communication skills with experience interacting with Providers and/or Billing Agencies. 
• Proven track record of provider partnerships to drive resolution of provider/payer related issues and risks. 
• Customer Service Acumen
• In depth knowledge of managed care
• Intermediate to Advanced proficiency in Microsoft Excel
• Negotiation skills
• Business knowledge and acumen within the Medicare and Medicaid product lines of business
• Business knowledge and acumen with Patient Driven Grouping Models (PDGM), Per Visit (Fee for Service) and episodic claims adjudication

What we offer:

• Salary Range: $45000 - $50000 / Year plus corporate bonus incentives
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement
• PayActiv - access earned income in between pay checks
• Walgreens Discount - receive up to 25% off eligible items
• Great culture with a sense of community

CareCentrix maintains a drug-free workplace

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.