Provider Reimbursement Representative.
Where
- Wausau, WI
What you'll be doing
- The Provider Reimbursement Representative develops programs and strategies to ensure that contracted rates and reimbursement policies are applied accurately for UMR. Analyzes claims, pre and post-payment, to ensure contracts and reimbursement policies and procedures are priced accurately. Reviews claim disputes to verify correct pricing and analyzes claim Inquiry data to determine root cause of errors; recommends system changes, training, and process improvements to prevent future errors. Works with both internal and external customers to identify and resolve complex problems. Assists company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies. Fee schedule and contract template maintenance is also included in this function. Apply knowledge/skills to a range of moderately complex activities. Demonstrate great depth of knowledge/skills in own function. Sometimes act as a technical resource to others in own function. Proactively identify solutions to non-standard requests. Solve moderately complex problems on own. Work with team to solve complex problems. Plan, prioritize, organize and complete work to meet established objectives. May coordinate work of other team members.
What your background should be
- 2+ years of experience with claims processing system within UMR and previous healthcare customer service experience. Basic (or higher) level of proficiency with Microsoft Word and Excel. Previous experience with Microsoft Access and PowerPoint. Previous experience with claims processes, workflows and management reporting.
Required Schooling / Training
- High School diploma/GED.
Who is the client company
- Managed healthcare Industry.
- If you are interested in this position, send your resume to apply@kochdavis.com
