Summary of Position
Serve as the key operational liaison with Provider Network Management and Finance: responsible for the reconciliation, reprocessing/recoupment and provider communication for claim payment integrity challenges. Oversee contract review; ensure that contract provisions are in alignment with corporate goals. Develop and implement dashboards to monitor performance. Drive discussions directly with all Provider back office operations to resolve claim processing disputes, including over and under payments, in a timely manner with engagement from the Provider Network Management Relationship Managers to ensure the discussions follow the contractual agreement.
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