Operations Specialist

Job Summary

A company is looking for an Operations Specialist III to provide analytical support and leadership for key Claims-related projects.

Key Responsibilities

• Conduct regulatory reporting and serve as a high dollar claims reviewer
• Identify payment integrity issues and prepare responses to legal correspondence
• Act as primary Claims Representative for corporate projects and external audits

Required Qualifications

• Bachelor's degree or equivalent years of relevant work experience required
• Minimum of five (5) years of experience in a healthcare claims environment or equivalent
• Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10, and HCPCS coding
• Demonstrated understanding of claims operations related to managed care
• Experience with data analysis and trending skills