- Evaluate disputed claims in denial management process for system configuration, claims processing, and/or contractual issues to facilitate Health plan review of claims.
- Collects data from clients relating to claims and escalate to management.
- Understand Department needs and recommends resources for process improvements.
- Assists with special assignments and projects that require extensive and thorough research.
- Performs outbound calls to Health Plans to investigate aging reconsideration submissions and claims payment details.
- To provide analysis and facilitation of issue resolution for our health plan clients.
- Deliver timely analysis of claims in response to providers.
- Storing and maintenance of multiple electronic documents.
- Bachelor's Degree or minimum of 3 years related work experience in a similar role.
- 3 years medical, billing and coding required.
- Some Understanding of health insurance claims and terminology
- Basic knowledge of Microsoft Office Suite products
- Some experience working with Health Savings Accounts
- Demonstrate ability to problem solve and utilize analysis, experience, and judgement to make accurate decisions.
Analyst, Operations Performance - Tampa, FL, United States - Avalon Administrative Services, LLC dba Avalon Healthcare Solutions
Description
Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes.
Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.
Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs.
Avalon helps ensure delivery of the right test, at the right time, and in the right setting.Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.
Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.
Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran.We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
For more about Avalon, please visit our web site atAbout the
Customer Success Operations Analyst:
The Customer Success Operations Analyst (CSOA) will be a part of the Network Claims Operations Department but will also provide inter-department support.
Responsibilities will include claims coding and editing investigation, communicating relevant claims decisioning and impact analysis to providers and health plan clients via ticket submissions or other mechanisms.
This role will also include performance of outbound calls and email communications to clients for status updates on claims issues to facilitate issue resolution.
The CSOA will be expected to fax documentation weekly to the health plans and meeting departmental quotas, KPIs and quality standards.
Additionally, the CSOA collects data from clients and claims to determine trends, provide feedback and work with management to create business process.
This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida may be required.
Customer Success Operations Analyst - Essential Functions and Responsibilities: