- Remediate impacted high dollar multi-claim issues (request and analyze claim impact reports & initiate sweeps), investigate the outcome of claim payment or denial for provider escalations through the PIR support process.
- May adjust claims for a specific line of business and market within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of claims, analyze systems and processes that span across multiple operational areas and claim systems, recommend resolution for a contract dispute, non-routine claim issues, billing questions, and other practices, identify barriers and participates in process improvement projects and coordinates communication processes on medical policy, reimbursement, and provider utilization patterns.
- May serve as a liaison with internal and external business partners.
- Collaborates with internal and external business partners to determine root cause and solve for appropriate resolution.
- Requires a high school diploma or GED.
- Requires a minimum of 6 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the healthcare industry which would include internal and external customer service experience; or any combination of education and experience, which would provide an equivalent background.
- Commercial claims experience is strongly preferred.
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law
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Provider Escalations Analyst - Columbus, United States - Elevance Health
Description
Provider Escalations Analyst
Location: The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
*Hours: Monday - Friday 8:00 - 5:00 pm ET
The Provider Escalations Analyst is responsible for Provider Issues Resolution (PIR) escalations across all lines of business and is responsible for the resolution of provider payment escalation requests and communication of contracts along with medical and clinical policies.
How you will make an impact:
Minimum Requirements:
Preferred Skills, Capabilities, and Experiences:
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $27.38 to $41.07.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Provider Escalations Analyst professionals in Columbus
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