Job Description
The Certified Corrected Claim Resolution Analyst will be responsible for researching and auditing medical records for complex, diverse, multi-specialty provider claims to identify and determine appropriately coded billed services when compared to the Zelis Claim Edits Product.
The Certified Corrected Claim Resolution Analyst is responsible for processing, escalating, routing, and responding to complex incoming Client and Provider corrected claims and inquiries.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day.
We are an equal opportunity / affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances.
If you need assistance and / or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to .
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy : .
Required Skills & Experience
3+ years of relevant experience or equivalent combination of education & work within healthcare payer or provider.
Certified coder (CCS, CCS-P or CPC), or RN, LPN with coding certification is required.
Knowledge of healthcare reimbursement policies, state and federal regulations and applicable industry standards.
Knowledge of correct coding and industry standard claim adjudication guidelines and policies.
Ability to translate coding and adjudication guidelines, policies, and references into edit policies and rules
Excellent verbal & written communication skills with project management experience
Proficient in Microsoft Office suite (Word, Excel, Power Point etc.)
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching.
Employees in this role are also entitled to paid sick leave and / or other paid time off as provided by applicable law.
Certified Correct Claims Resolution Analyst
The Certified Corrected Claim Resolution Analyst is responsible for processing, escalating, routing, and responding to complex incoming Client and Provider corrected claims and inquiries. The Certified Corrected Claim Resolution Analyst will be responsible for researching and auditing medical record...
Case Manager- Correctional AIDS Project (CAP)
ESSENTIAL DUTIES AND RESPONSIBILITIES.Interview program participants.Develop relationships with participants.Provide Discharge Plans for HIV/AIDS incarcerated participants in State Prison and halfway houses.Conduct orientations in State Prisons, Halfway House and other facilities about our program a...
Environmental Project Manager (New Jersey)
You will lead investigation and remediation efforts associated with site cleanup, design projects, and other environmental remediation-based projects. In this role, you will use established relationships with clients and regulatory agencies to procure and manage project scope, schedule, budget, and ...
Consultant Manager-Pharma Biotech Data Scientist
Provide subject matter expertise on commercial data and analytics, such claims, EMR, formulary data. Pursue and secure new business, which includes aligning client business problems to data/analytic plans, collaborating with advisory teams, identifying scalable solutions and services, and presenting...
Agile Project/Program Manager
The Agile Project Manager will be responsible for planning, leading, organizing, and motivating agile project teams. Expert knowledge of Agile project management practices PMI-ACP, CSM, or equivalent preferred Experience overseeing projects with at least 10 team members including developers, quality...
Senior Software Engineer - MySQL Data Infrastructure
The DataHub Engineering team provides a distributed platform for hosting datasets, complete with managed data stores, search, discovery, lakehouse and real-time stream processing capabilities. The DataHub's DataOps and Infrastructure team designs, engineers and operates the infrastructure powering t...
Technology and Data - Specialty Software Engineer 4 - Contingent
Job Description: In this contingent resource assignment, you may: Consult on complex initiatives with broad impact and large-scale planning for Specialty Software Engineering. Review and analyze complex multi-faceted, larger scale, or longer-term Specialty Software Engineering challenges that requir...
Civil Construction Project Manager
A civil construction project manager oversees the planning, execution, and completion of construction projects, ensuring they are delivered on time, within budget, and to the required quality standards. The Project Manager will have opportunity to learn about all different areas of construction. Dir...
Senior Principal Scientist, AI/ML applied to Drug Design - Data Science Analytics & Insights
The Data Science and Digital Health Analytics & Insights team within Johnson & Johnson Innovative Medicine develops innovative solutions using a variety of data sources across multiple different disease areas, encompassing oncology, cardiovascular and metabolic disorders, immunology, neurosc...
Programmer Lead Data Scientist
The Violence and Inequality Project (VIP), part of the Princeton School of Public and International Affairs, is seeking a full-time Programmer/Data Scientist. Collaborate with cross-functional teams, including data scientists, domain experts, and stakeholders, to define model objectives and paramete...