Conduent Research and Correspondence Analyst in West Sacramento, California

Research and Correspondence Analyst

Description

The Research Analyst is responsible for researching and resolving high-profile complex issues that have been referred by the Department of Health Care Services, Conduent’s internal customers, Conduent Management, as well as provider billing issues received from providers via written correspondence.

Tasks and Responsibilities

  • Conducts in-depth research of provider billing issues and provide resolution via written correspondence or E-mail to the Department of Health Care Services

  • Respond to External Customer via email on research findings

  • Analyzes claims billing issues and problems to identify root cause and makes recommendations for Improvement

  • Work with different internal and external units for claim resolution

  • Able to interpret Medi-Cal Policy

  • Prepping of claims for internal resubmissions

  • Monitor individual queue and response to written inquiries within the units Service Request Level Agreement

  • Timely follow up and tracking of claims

  • Participates in Xerox-required employee training

  • Assists with updating of Procedure Manuals, as required

  • Document information into CRM

  • Able to communicate on research findings via written response

  • Work independently with no supervision and make decisions related in provider research issues and high profile issues

  • Acts as SME’s for Systems Group and assist with solutions related to systems changes

  • They drive projects directed by DHCS for claim resubmissions and coordinate conference calls with provider, DHCS, and Associations

  • Works directly with File Maintenance on system issues and make recommendations for corrections

  • Assist/recommend Edit Criteria verbiage based on revised policy

  • Attends SDN meetings

  • Able to read system tables and provide support to DHCS and SG on recommended changes

  • Works on legislative issues that have been escalated from providers, DHCS or Xerox

  • Acts as Expert Witness for the claims processing system

Required Education/Experience/Qualifications

  • High school Diploma or corresponding years of experience can be substituted for education

  • Minimum two years’ experience in claims examination and/or billing practice

  • Minimum one year experience with CA-MMIS billing policies and procedures

  • Outstanding oral and written communication skills, strong interpersonal skills, and superior

Organizational abilities

  • Ability to take initiative, to maintain confidentiality, to meet deadlines, and to work in a team

Environment essential

  • Solve problems through analysis and ongoing feedback

  • Ability to use MS Word, MS Excel, and MS Outlook required

Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.

We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.

Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com .

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form at https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf .

Job Customer Care

Primary Location United States-California-West Sacramento

Organization Government

Unposting Date Dec 20, 2018, 11:59:00 PM

Req ID: 18029370