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Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
Posted 1 day ago
Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description 65% May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may
Posted 1 day ago
Through effective, professional Customer Relationship Management, consults with customers to understand their needs and how CPSS' services may identify and address their business problems/opportunities. Provides research, analysis and leadership on individual and team work assignments, making decisions independently with guidance from manager. Using in depth analysis, recommends creative and effec
Posted 1 day ago
Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plan
Posted 1 day ago
Under general supervision, responsible for interpreting, reviewing, and analyzing benefit plan designs. Responsible for creating scope, design and specification documents for programming of benefits from benefit plan designs. Responsible for programming and / or auditing benefits within the Benefit Files and / or RULEs databases to ensure timely and accurate claims and eligibility processing. Assi
Posted 1 day ago
Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 40% Responds to written and/or telephone inquiries according to desk procedures
Posted 1 day ago
Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 40% Responds to written and/or telephone inquiries according to desk procedures
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizati
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk in inquiries. Accurately documents inquiries. 15% Initiates or processes adjustments or performs other research as needed t
Posted 1 day ago
Screen, code and key claims in claims system. Ensure claims are processed in a timely manner. Description 80% Screen, code and key claims to ensure proper and accurate adjudication of claims in accordance with departmental standards for quality and production, contract regulations, policies and guidelines. 10% Correct keying errors as noted by system edits. 10% Accurately use medical review form
Posted 1 day ago
Establishes and maintains provider networks for assigned lines of business. Serves as main contact for all recruiting or recontracting efforts and all contract questions or issues that arise with providers. Recommends and implements cost effective strategies while delivering high quality products to customers. Description 40% Conducts initial/renewal contract negotiations with providers. Perform
Posted 2 days ago
Responsible for analysis, design, programming, and implementation of complex applications tasks and projects. Devise feasible, logical procedures to resolve business problems through the use of computer resources. Formulate scope and objectives through research to develop or modify complex systems. Review detailed specifications and recommend modifications. Design, code, test and debug complex app
Posted 5 days ago
Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Description Work hours 8 00 am to 4 30 pm. Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters clai
Posted 5 days ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquires may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk in inquiries. Handles si
Posted 5 days ago
Responsible for operating high speed, file based integrity production mail inserters and other print/mailing equipment to meet the company's required contractual obligations related to mailing first class correspondence, statements, checks, etc. Mail procedures require the adherence to the USPS regulations governing mail and adherence to federal privacy regulations. Description 65% Operates all
Posted 5 days ago
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