Job Purpose:

Ensure all agents are completing timely and accurate department work. This position is also responsible for collecting, organizing, and analyzing data to improve the predictability of payer trends and claim adjudication outcomes.

Job Duties and Responsibilities:

1. If needed, maximize productivity while performing timely claim follow-up, initiate proactive daily outreach to negotiators to confirm receipt of responses or clarify counterarguments, ensuring effective communication and resolution of any discrepancies in the claim adjudication process. 2. Take full ownership of follow-up, research, and coordination efforts to identify and track proposed negotiations and/or claim denials across various channels, including the portal, scanned documents, faxes, and emails, ensuring that all relevant data is organized and easily accessible. 3. Document and update critical information in Collaborate MD regarding payments, ensuring that all entries are accurate and timely, and effectively organize work schedules around Jira due dates to maintain workflow consistency. 4. Leverage multiple data sources, including but not limited to CMD, Anthem Claims Routing tool, Kipu, Reimbursement Tool, and Availity, to analyze past payment rates and identify patterns for similar members or facilities, enhancing decision-making and negotiation strategies. 5. Handles high-level escalations for BPO agents and escalates complex claims and challenges promptly to the Department Leadership, ensuring that all concerns are addressed in a timely and effective manner, while maintaining a high standard of customer service and issue resolution. 6. Maintain awareness of net gain/loss metrics and KPIs to stay in touch with the outcomes of assigned work, and use this insight to inform priorities, performance, and improvement opportunities. 7. Ensure and support BPO agents with daily negotiations and weekly and monthly TPP submissions and audit BPO claim work for accuracy, completeness, and compliance, identifying training gaps or errors for corrective action. 8. Track BPO KPI's and report underperformance to the Department Leadership to support action planning. 9. Participate in the department's L10 meetings, identify and bring issues, and develop and execute quarterly rocks to drive alignment and improvements toward Cipher VTO. 10. Perform other related duties as assigned.

Pay:

$23.00 - $28.00 per hour

Benefits:

401(k) Dental insurance Employee assistance program Health insurance Health savings account Life insurance Paid time off Parental leave Professional development assistance Vision insurance

Experience:

Behavioral Health:

1 year (Preferred) Ability to

Commute:

Costa Mesa, CA 92626 (Required)

Work Location:

In person