Market Liaison Resolution Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Successfully resolving Operational Intakes through the Market Liaison Support Services Research Team

• Perform comprehensive reviews and document the findings

• Collaborate with multiple departments such as contracting, credentialing, claims, and IT

• Investigate tasks related to Market State Complaints

• Adhere to Service Level Agreements (SLA)

• Create reports to assess the impact of claims

• Modify affected claims and assist with adjudication

• Identify potential opportunities for process enhancements

• Engage in User Acceptance Training for system-related issues

• Communicate effectively with internal teams

• Proactively support the market by assessing risks

⛳️ Requirements

• A Bachelor's degree is required

• A minimum of two (2) years of experience in managed care operations is necessary

• Familiarity with Medicaid and Medicare

• Knowledge of the healthcare industry

• Understanding of Provider Contracting applications

• Advanced skills in troubleshooting and problem-solving

• Comprehensive understanding of Managed Care Operations-related systems, medical coding, technical specifications, and processes

• Strong grasp of claims processing

• Proficient in Microsoft Office Suite

• Excellent organizational, time management, and prioritization abilities

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Opportunities for professional development

• Bonuses