Remote 
Operations Analyst I
 MultiPlan | |
 United States | |
 Apr 08, 2025 | |
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Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions. Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine! This position assists with workflow distribution, claim research, documentation processing, and operational/service pilot projects in support of MARS Clinical Review operations.
JOB ROLES AND RESPONSIBILITIES:
1. Review, investigate, and analyze claim appeals, working closely with coders to coordinate review of documentation. Assist customer service, providers, and clients on resolution of issues or inquires.
2. Research and manage claim inventory for inpatient, outpatient, and provider billing using review guidance supplied by our clinical teams. 3. Request and process documentation associated with special projects and clinical review inquiries. 4. Access, research, and retrieve information and documentation from MultiPlan and one of various external client systems. 5. Data Entry and database maintenance including review, validation, and maintenance of provider data. 6. Perform system claim adjustments based on appeal outcomes or to process corrected claims. 7. Manage manual distribution of workflow when system is unable to assign. 8. Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed 9. Collaborate, coordinate, and communicate across disciplines and departments. 10. Ensure compliance with HIPAA regulations and requirements. 11. Demonstrate Company's Core Competencies and values held within. 12. Please note: due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role. 13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. JOB SCOPE:
This position works independently under general supervision to complete the outlined job responsibilities by applying knowledge of claims and department processes. Work involves applying advanced skills using systems and tools in support of MARS operations. Duties and tasks are focused internally on high volume processes. The incumbent resolves routine questions and issues while referring more complex issues to higher levels for resolution.
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