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Senior Claims Research & Resolution Professional
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Full-time
- Become a part of our caring community and help us put health first
- The claims review professional works in collaboration with the chief information officer (CIO) to ensure timely and accurate submission of encounter data and works with special investigation unit (SIU) on matters that require SIU review or investigation.
- Works with the Special Investigation Unit (SIU) Manager to assure that service billing and utilization issues are documented and reported appropriately.
- Partners with the Provider Education and Outreach team to identify targeted training for Home-and-Community Based (HCBS)/Long Term Service Support (LTSS) providers.
- Responsible for annual and quarterly State reporting of grievance and appeals.
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