Reconciliation Claims Project Specialist

Regal Medical Group is an affiliated Independent Physician Association (IPA) of Heritage Provider Network.

 

The Reconciliation Project Specialist, Claims is responsible for performing simple to complex activities related to hospital and professional reconciliations.  This includes oversight of all workflow, research and documentation under limited supervision by the Vice President, Claims.  Identifies potential company risks and implements appropriate courses of action and develop strategies to reduce disputed claims.  Analyzes all relevant information to track and trend the reconciliation outcomes to provide findings to appropriate RMG management.

 

 

 

REQUIREMENTS

 

·  Bachelors degree from a 4-year accredited university

·  3-5 years experience in a project management or data analysis/systems capacity

·  2-4 years healthcare industry experience

·  MBA; MIS preferred.

·  Strong ability to collaborate with senior leadership and other project managers to define business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery results

·  1-2 years supervisory experience preferred

·  Should exhibit a disciplined, process and data-driven approach and methodology 

·  Knowledge of claims payment policies preferred

·  Requires strong leadership, mentoring, organizational and communication skills

·  Must be able to function with minimal supervision and be able to prioritize all work tasks 

·  Demonstrated ability to conduct and interpret qualitative and quantitative analysis and problem-solving skills 

·  Excellent verbal and written presentation and communication skills 

·  Ability to work well with individuals in all levels of the organization; Must be an effective team player

·  Demonstrated ability to exercise initiative, independent judgment and be a self-starter 

·  Strong PC-based business software skills including MS Office suite (Access, Excel, PowerPoint, Word), Project, Visio and report writers 

 

Full benefits package including Employer Paid Medical, Dental and Life Insurance.


If interested please forward your resume to careers@regalmed.com or fax to 818.357.5029

Visit us on the web at www.regalmed.com