Imagenet LLC · 2 days ago

Sr Claims Specialist Provider Dispute Resolution - Tampa, FL

Greater Tampa Bay Area

Full-time

Remote

Mid Level

3+ years exp

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Responsibilities

Monitor and analyze claims processing performance metrics, identifying areas for improvement and implementing corrective actions.

Ensure strict adherence to payer contracts, regulatory requirements, and internal policies related to claims processing.

Analyze claims data and generate reports to identify trends, opportunities for cost savings, and process enhancements.

Monitoring service level agreements.

Participate in the evaluation and implementation of new claims processing systems and technologies.

Prepare and present regular reports on claims operations performance, productivity, and financial metrics to senior leadership.

Develop and implement strategies to optimize claims processing workflows, enhancing efficiency, accuracy, and turnaround times.

Develop and implement training programs to ensure staff competency and knowledge of claims processing best practices.

Qualification

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Medical claims processingClaims adjudicationMedical codingBilling practicesReimbursement methodologiesData analysis toolsProject management methodologiesHealthcare regulations knowledge