Use your operational analytical skills to design, develop, program, maintain, and publish reports and reporting applications Meet with business partners and gather reporting requirements, offer recommendations and different options to meet their reporting needs Customized application and report development, automation, and technical support of the data warehouse and repor

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

Creating and maintaining provider demographic, billing, and network contract information within a database Audit provider loads for adherence to quality measurers and reporting standards Recommend methods to improve processes used by department You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Acts as primary CAHPS Manager Collaborating with leadership, develop and drive tactical plan that can be leveraged across the enterprise to achieve CAHPS goals Manages vendor relationships to support CAHPS program Analyzes key KPI's and data to derive progress and opportunities for improvement Establishes and reviews performance metrics on a regular basis to ensure effort