RESEARCH & RESOLUTION ANALYST (IRVINE, CA)

 

POSITION OVERVIEW

 

This individual is a liaison for the TC³ clients and the networks. The Research & Resolution Analyst is assigned a client base. The analyst must have excellent communication skills both written and verbal and be detailed oriented with solid problem solving and decision-making skills.  Analyst is responsible for managing client and network inquiries in a professional and timely manner, as well as addressing complex issues and resolving them effectively through interaction with internal departments and/or external contacts.

 

BRIEF OVERVIEW OF RESPONSIBILITIES

• Accountable for PPO provider disputes/inquiries
• Resolve disputes/inquires in a timely manner
• Identify dispute patterns
• Answer 800 customer service numbers assigned to certain clients
• Track adjustments for accounting purposes
• Maintain weekly disputes Excel spreadsheets at the client request/requirements
• Must address and/or resolve a minimum number of claims per day (details will be provided)
• Update Provider TIN Exclusion list
• Build a good working relation with the network partners and clients
• Assess current process and procedures; make recommendations for improvement and implement such changes if/when necessary
• Other duties as assigned 

KNOWLEDGE AND SKILL REQUIREMENTS

• Excellent computer skills
• Great communication skills both verbal/written
• Outstanding customer service skills

CONTACT

 

csjobs@tc3health.com

 

CLINICAL DATA SPECIALIST (MINNETONKA, MN)

 

POSITION OVERVIEW

Serve as a clinical data resource within the Payment Integrity unit of TC³ Heath.  Provide clinical expertise and analysis with a focus on post-payment review.  Utilize data algorithms to identify focused areas of review with resultant cost savings.  Work with the Clinical Operations team to identify patterns and trends, utilizing Data Analytics as a tool.   

QUALIFICATIONS

·         Current RN Licensure

·         Strong clinical background with a minimum of 5 years experience

·         Excellent written and verbal communication skills

·         Demonstrated analytical problem solving skills

·         Self motivated and able to work effectively with others to accomplish common goals

·         Healthcare industry experience preferred, especially working with claims and/or providers

·         Knowledge of industry terminology and regulatory information

 

CONTACT

 

nsjobs@tc3health.com