GENERAL SUMMARY
Responsible for analyzing, coding, and building provider demographic and payment information and/or client provider network information into the transactional system and other databases. Works closely with customer
service/claims, account management, and/or Provider Service Representatives to solve provider contract, group data, and/or claims issues. Acts as a consultant to the health plan and customer service/claims regarding system capabilities and limitations. Serves as technical resource on products and technology.
ESSENTIAL RESPONSIBILITIES
- Evaluates and builds provider demographic, contract, and/or client provider network information into the transactional system and other databases.
- Extracts and interprets data from the transactional system for analysis and system setup.
- Facilitates resolution of provider, group, or contract related claims issues.
- Supports accurate claims auto-adjudication and accurate claims payment.
- Serves as a consultant to health plans and customer service/claims in interpreting data and developing new products and strategies.
- Acts as an interface between health plans and customer service/claims. Coordinates system support as necessary.
- Analyzes the impact of process or technical changes on existing processes and interfaces based on cross-functional knowledge of transactional systems and customer service operations processes.
- Participates in business improvement project teams.
- May lead cross-functional user groups in optimizing the use of existing transactional systems and reports. May perform user system training.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent. Bachelor's degree preferred.
- Previous (2-4 years) provider maintenance, claims processing or coding experience required.
- Thorough knowledge of coding (CPT, REV, ICD-9, HCPCS).
- Proficiency in Excel required, knowledge of Access desired.
- Strong project management skills and analytical skills.
- Excellent communication skills, both written and verbal.
- Ability to work on cross-functional teams.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: West Sacramento, CA, US
Organization: 10750 - Service Center - Central Admin
Schedule: Full-time
Job Posting: 2013-01-31 00:00:00.0
Job ID: 1310230