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Risk Management Analyst - Plano, United States - Elevance Health
Description
Risk Management Analyst - TexasA proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.
Location:
This position will work a Hybrid Model (remote and office).
Ideal candidates must live within 50 miles or a 1 hour commute to the Elevance Health Office in Plano, Texas.
Work Shift Hours:
Monday through Friday, Business Standard Hours (CST).
The
Risk Management Analyst
is responsible for Responsible for supporting the department regarding all aspects of the corporate insurance program.
How you will make an impact:
Gathers, records, and maintains credentialing information for new payor contract applications and renewals.
Primary duties may include, but are not limited to: Performs department credentialing and contracting functions including, ongoing maintenance and reporting network access gaps.
Maintains the departmental payor activity library. Maintains, tracks, and renews payor credentialing for all lines of business.Produces credentialing reports as needed.
Acts as a liaison between contracting and internal departments coordinating claims denial interventions, tracking resolution, and implementing ongoing solutions.
Acts as a contact to the payor for missing or additional credentialing documentation requirements.
Minimum Requirements:
Requires a BA/BS; or any combination of education and experience, which would provide an equivalent background
Preferred Skills, Capabilities and Experiences:
Manage multiple applications at once and work efficiently to meet or exceed deadlines
Ability to correctly interpret and utilize provider taxonomy, NPI, and other identifiers in payor credentialing applications
3+ years experience in completing payor credentialing applications through various methods
Navigating Icertis Contract Management or any other contract management software
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