Core Responsibilities Include: Investigating, reviewing, and providing clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review.
Ability to travel up to 50% of the time. Bachelor's degree. 5+ years combined experience with clinical quality, health care analytics, or driving clinical transformation initiatives with population health programs, Patient Center Medical Homes or in Accountable Care Organizations.
2+ years of experience in provider data analysis. 2+ years experience with claims processing or resolution and medical coding. 1+ years of experience working with reporting tools and generating effective reports. Ability to convey complex information to others and make it more easily understood.
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