Cost Containment Analyst

JOB SUMMARY

This position is responsible for identifying and analyzing cost saving opportunities including establishing and maintaining all phases of reinsurance filing, interpreting stop loss contracts, meeting filing deadlines and maintaining correspondence and tracking logs.

JOB QUALIFICATIONS

High School diploma/GED equivalent required. Minimum of 2 years- experience in a managed care setting.

ESSENTIAL FUNCTIONS

All duties and responsibilities are essential job functions and are subject to possible modification to reasonably accommodate individuals with disabilities. Other functions and accountabilities may be assigned from time to time. Regular attendance is an essential function of this position. To perform this job successfully, the employee will possess the skills, aptitudes, and abilities to perform each duty proficiently.

TYPICAL PHYSICAL DEMANDS

Requires prolonged sitting. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, fax machine and other office equipment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Identify, develop and implement cost saving opportunities. Performs adjustments. (JAA and MCS) Works Blue Cross JAA reports Communicates with Anthem via emails regards to Claims status Performs voids and reissues Works JAA reconciliation reports Splits RFF for Stoploss Request provider/ member overpayments. Oversees Third Party liability process. Track error trends and provide feedback to appropriate departments. Attends meetings and training sessions as required. Maintains strictest confidentiality. In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.

PERFORMANCE REQUIREMENTS

Knowledge, Skills and Abilities:

Knowledge of various systems and software technologies. Knowledge of third-party liability process. Knowledge of principles of mathematics, healthcare administration, statistics, and interactive data systems. Skill in identifying, developing and implementing cost-saving opportunities. Skill in planning and organizing. Skill in evaluating the effectiveness of existing methods and procedures. Skill in operating a variety of office equipment. Ability to train others in various systems and software applications. Ability to exercise initiative, judgment and decisionmaking. Ability to conduct studies and research with minimal supervision. Ability to work cooperatively with internal and external customers. Ability to communicate clearly with customers and co-workers.

Compensation / Pay

Rate (Up to): $20.00 - $25.00