Analyst - Network Analytics

The main goal of the position is to improve provider satisfaction through reducing denials and rejections by provider awareness and education, system remediation and enhancement, and through focused analysis on the drivers of these denials and rejections. This position receives/responds to provider claims issues, escalations, and complaints, including inbound requests from Providers or callers from Health Plans that are requesting assistance from a Supervisor. The analyst may also assist with inbound phone calls, if business needs arise. Researches root cause by reviewing the following (but not limited to): plan, eligibility, patient notes, and authorizations to determine appropriate resolution and follow up for complete handling of issue. Works with CSC, Network Management and/or RCM to identify areas of opportunity and recommend solutions. Completes special assignments and analyzes provider requests. Assists other departments and interacts directly with providers. Proactively outreaches to providers to educate on opportunities and trends identified during claims analysis. Subject matter expert responsible for facilitating decisions regarding best practices and subsequent effectiveness of process changes which will ultimately support smooth and effective business operations.

In this role, you will:

• Handle various provider claims escalations, complaints, and special projects which include researching, resolving, and documenting provider claims issues.
• Proactive outreach to providers to educate after analyzing data to identify trends resulting in claims issues.
• Tracks errors and communicates to up-line management for coaching and training purposes.
• Track and summarize claims analysis for Executive review.
• SME support on claims triage with Providers Services/RCM and Network Management to ensure remediation and minimize future issues.
• SME support for scripting and educating NST on new releases, projects/initiatives, system issues, new implementations, and process changes.
• Analyzes data and determines if CareCentrix guidelines have been followed by CSC when researching plan, eligibility, and patient information.
• Participates in and contributes to performance improvement activities.
• Participates in special projects and performs other duties as assigned.
• Minimal travel requirement

You should reach out if you have:

• Bachelor's Degree preferred with 1+ years of related experience.
• Excellent communication (verbal/written), problem resolution, organizational and interpersonal skills.
• Ability to function in a fast paced environment, the capability to work in a highly efficient manner, the proficiency to multi-task, and the ability to prioritize workloads is critical.
• Time management skills to work on a variety of projects under specific time restraints
• Successfully fulfills work assignments with a high level of accuracy
• Must have the ability to interact with all levels (from associates to senior executives).
• Must be detail oriented, be responsive, and demonstrate independent thought, good judgment and critical thinking
• Must be able to problem solve difficult situations with internal and external customers, and with process and/or system issues.
• Must have the ability to visualize, listen and resolve customer inquiries, while demonstrating a positive persona of the Company.
• Strong analytical, problem solving, and communication skills required.
• Experience in the managed healthcare service industry, with knowledge of the insurance/managed care/reimbursement and customer service industry is preferred.
• MS Office proficiency including:Word, Excel, PowerPoint, Access and Outlook.
• Certified Professional Coder (CPC) is a plus

What we offer:

• Salary: $45000 - $65000 / year plus corporate incentive program
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement opportunities, professional skills training, and tuition Reimbursement
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

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We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

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