Opportunity Description
Our Client, an IT Services and Consulting company, is looking for a Senior Consultant for their Remote location.
Responsibilities:
Payment Operations and Payment Integrity Workstreams: Implement a process to test end-to-end common Medicare Advantage leakage scenarios across multiple Medicare service categories to rapidly determine whether any common issues are relevant at Blue Cross NC. Provide recommendations on priority focus areas based on prior leakage experience. This assumes tiger teams will implement end-to-end fixes for authorization-to-claim matching and the lesser-of rules across all Medicare services. MOOP Accumulator Accuracy (Part C only) If the system triggers $ prematurely, the plan absorbs avoidable medical cost. Test that MOOP applies only after the precise allowed in network Part A/B amounts are reached. No Surprises Act (NSA) — Ensure Not Over Applying Protections NSA requires in network c...
Full-time
Business Operations Specialists