Health recognizes the vital role providers play in enhancing our service delivery to the member. A highly engaged provider network is critical to ensure members receive the right care at the right place for the right amount of time. The Auth Resolution Analyst works under the direction of the Manager, Provider Records to ensure accurate and timely maintenance of critical provider information relating to authorizations and claims issues. The Auth Resolution Analyst primary functions are to apply basic technical skills to analyze, diagnose and resolve claims issues.
Serve as a Subject Matter Expert (SME) for more complex health plans regarding analysis, troubleshooting and root cause analysis.
Ensure accurate and timely maintenance of complex provider information and synchronization of data on all claims related issues including expertise on business requirements for multiple business regions.
Research and resolve complex exceptions and error reports.
Assist in problem identification, analysis, and resolution for multiple system provider database issues.
Ensure that specific divisional targets for authorization integrity and provider satisfaction within the scope of the assigned program are achieved.
Assist in the training of less experienced associates.
Perform other duties and responsibilities as required, assigned, or requested.
Bachelor's degree in related field; or any combination of education and experience, which would provide an equivalent background
3 - 5 years of health care experience in claims, provider data, authorizations and/or project management
Claims and authorization experience as it relates to claim denials and resolution
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Intermediate or advanced analytical skills (Excel, Access, other data management or data modeling) a plus but not required
Knowledge of SQL highly preferred
Exceptional written and verbal communications skills
Ability to manage work internally both upwards laterally and externally; this position will interact frequently with the Network development team as well as external and internal customers
Energetic, motivated, self-starter; capable of managing multiple objectives at once
Excellent problem solving and analytical skills
Strong organizational and time management skills; ability to prioritize work to efficiently meet company objectives
Ability to travel up to 10% of the time may be required
Being a pioneer in post-acute management and care transitions with 19 years of experience, navi
Health is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. We provide clinical service support alongside proprietary technology and advisory solutions that empower health systems, health plans and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes.
We care about the people we serve.
We care about each other.
We care about our communities.
We embrace innovation.
We like simple.
The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. navi
Health reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability.