23:27
Annapoorna
WellCare - Tampa, FL - . Manages the external Provider Dispute Process, supporting the front line Provider Resolution Team, evaluating escalated disputes and supporting the Medical Director review process. Essential Functions: * Manages the external Provider Dispute Process by researching and evaluating escalated disputes and supporting the Medical Director review process. * Manages research of claims coding rule initiatives including the development of detail work plans. * Receives and logs requests of changes and appeals... from a regulatory perspective, financial perspective, and claims operational perspectives. * Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes. * Identifies coding error (e.g., upcoding, bundling/unbundling) and recommends correct coding of medical claims. * Researches CMS/State laws and AMA guidance. * Presents change proposal to committee. * Communicates effectively to markets. * Develops relationship with claims coding rule software vendors. * Receives...
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