CareCentrix

  • Analyst - Provider Services

    Job Locations US-CT-Hartford
    Job ID
    2018-6207
  • Overview

    The Analyst performs trending and analysis to support the provider service team with identifying trends and patterns that impact a provider’s cash flow. Sr. 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. Sr. Analyst is responsible to identify trends, root causes, and develops action plans to resolve root causes. Provides education to billing agencies and provider offices to ensure appropriate billing. Assumes an active role in developing strong provider relationships, evaluating provider performance, conducting financial evaluations, formulating tactical plans, and leading special projects. The quality and execution of the Sr. Analysts’ work is critical to the success of the Provider Services.

     

     

    Responsibilities

    • Conducts claims research to identify patterns and trends that cause a disruption to timely and accurate payment of claims.
    • Performs analyses to assess provider trends, process gaps and opportunities and to improve the overall provider experience.
    • Proactively develops and manages provider relationships.
    • Seeks to improve the provider experience through effective research and resolution to provider issues and concerns.
    • Participates actively to support or lead projects and tactical initiatives.
    • Collaborates and works well within both the Provider Service team and across other departments.
    • Collaborates with team members to derive trends, conclusions and recommendations based on the data and analyses.
    • Manages multiple tasks and projects, is detail oriented, responsive, and demonstrates independent thought and critical thinking.
    • Provides Provider Training on Policy and Process changes and other communications as necessary

    • Researches, resolves and tracks provider complaints.
    • Facilitates and participates in Provider Town Hall and onsite meetings as needed.
    • Performs analysis to assess claims processing trends, systems and business process gaps and recommend opportunities to improve the claims life-cycle process

     

    Qualifications

    • Bachelor’s Degree preferred, 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
    • Proven ability to establish priorities and achieve results
    • In depth knowledge of managed care
    • Advanced proficiency in Microsoft Excel, PowerPoint, Visio, Access
    • Ability to think strategically and translate into deliverable results
    • Problem solving abilities
    • Negotiation skills
    • Financial acumen

    CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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