Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.
The Provider Escalations Analyst will be responsible for Provider Issues Resolution (PIR) escalations across all lines of business and is responsible for the resolution of provider payment escalation requests and communication of contracts along with medical and clinical policies.
How you will make an impact:
Remediate impacted high dollar multi claim issues (request and analyze claim impact reports & initiate sweeps), investigate the outcome of claim payment or denial for provider escalations through the PIR support process.
May adjust claims for a specific line of business and market within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of claims.
Analyze systems and processes that span across multiple operational area and claim systems.
Recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices.
Identify barriers and participates in process improvement projects and coordinates communication processes on medical policy, reimbursement, and provider utilization patterns.
May serve as a liaison with internal and external business partners.
Collaborates with internal and external business partners to determine root cause and solve for appropriate resolution.
Minimum Requirements
High school diploma or GED
Minimum of 6 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry which would include internal and external customer service experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
FHPS professional and facility adjustments experience preferred.
FHPS processes and systems experience preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $25.00/hr. to $37.51/hr.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law
