The Provider Service analyst is responsible for ensuring consistent and timely claims payment to our providers occur. The analyst serves as a point of contact for our providers to handle accounts receivable issues and escalated claims resolution requests. The associate will be responsible to proactively monitor, track and trend providers’ cash flow and identify issues as a result of end-to-end claims adjudication analysis. The associate will coordinate research, conduct root-cause analysis and issue resolution in conjunction with business partners and the health plans to manage accounts receivable inquiries and issues.
As the point of contact to key providers, the associate will be responsible for facilitating regular meetings and workgroup sessions with the provider to review the identified trends and opportunities to improve the end-to-end revenue cycle management process.
The associate will also be responsible for the onboarding and continuous training of the provider regarding CareCentrix processes. The associate will be responsible for ensuring the provider understands how to navigate and effectively leverages the operational and service processes to be successful.
• Conducts claims research to identify patterns and trends that cause a disruption to timely and accurate payment of claims.
• Researches, resolves and tracks provider account receivable issues related to, but not limited to, provider contracting, pricing, portal, authorizations and other issues impacting the overall provider claims adjudication life-cycle.
• Performs analysis to assess claims processing trends, systems and business process gaps and recommend opportunities to improve the claims life-cycle process.
• Integrates multiple data sets from various systems to produce meaningful reports.
• Collaborates and works well across other departments to drive end-to-end improvements.
• Responsible for identification of process inter-relationships to provide deeper insight to management on business drivers behind the metrics.
• Partners with organizations external to CareCentrix to resolve provider and claims account receivable issues (e.g., health plans)
• Manages multiple tasks and projects, is detail oriented, responsive, and demonstrates independent thought and critical thinking.
• Seeks to improve the provider experience through effective research and resolution to provider issues and concerns.
• Proactively develops and manages provider relationships and facilitates various Joint Operating Committee (JOC), workgroup and ad hoc provider meetings.
• Provides provider training and onboarding of policy and processes and process changes. and other communications as necessary.
• Participates in special projects and performs other duties as assigned.
• Bachelor’s Degree preferred, with a business or IT concentration preferred.
• Health insurance industry experience required with a minimum of two to three 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
• Proven ability to establish priorities and achieve results
• In depth knowledge of managed care
• Advanced proficiency in Microsoft Excel, PowerPoint, Visio, Access
• Analyze trends in revenue cycle challenges, including denials and rejections, by mining data in Tableau and other reports to identify denial and rejection abnormalities.
• Prepare ad hoc and regularly scheduled reports on current, quarterly, and YTD revencue cycle performance for leadership and providers.
• Demonstrated ability to lead projects, demonstrate outstanding interpersonal skills; fosters and facilitates collaboration with internal stakeholders
• Ability to think strategically and translate into deliverable results
• Problem solving abilities
• Negotiation skills
• Financial and claims acumen
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.