|Required Experience:||3 to 4 years
The candidate will be a member of the Lab Management Program and will be responsible for designing, implementing, and monitoring lab services and testing product that remains in alignment with rapidly shifting commercial, Medicare, and Medicaid medical policy. This requires a working knowledge of policies and procedures coding, diagnosis coding, claims data elements, and claims system capabilities. Experience in a clinical labatory setting is critical with at least five years' experience. Major responsibilities include:
- Work with medical policy team to understand the policy goals and ensure appropriate associated coding and claims processing language.
- Perform analytics to model policy-based claims processing to ensure the expected outcomes in historical claims data.
- Coordinate claims configuration design, implementation, maintenance, customization, and documentation.
- Act as subject matter expert for claims disputes.
- Monitor claims product performance, including accurate processing, value metrics, trends, unusual billing patterns, and opportunities for enhancement.
- Manage projects to continuously improve the claims processing product.
Minimum Experience Required
- Bachelor's degree or equivalent work experience.
- Billing/Coding certification preferred.
- 3-5 years experience in a clinical laboratory setting.
- Solid understanding of claims data and processing systems
- Demonstrated experience using medical coding systems and databases
- Analytical, problem-solving nature with ability to work with data and reporting tools to research, organize, and summarize findings (Excel knowledge)
- Detail-oriented with the strong organizational skills required to track thousands of claims policies
- Self-motivated with ability to define projects, prioritize responsibilities in a fluid environment, and work with minimal instruction or supervision
- Excellent verbal and written communication skills as well as the ability to effectively interact with all levels of staff and management
This position is remote.