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.
• 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.
• Partners with organizations external to CareCentrix to resolve provider and claims account receivable issues (e.g., health plans)
• 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.
• Bachelor’s Degree preferred
• Knowledge of claim payment processes and systems is preferred.
• 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.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.