BILINGUAL RETENTION SPECIALIST - SPANISH/ENGLISH
One of Ajilons fortune 500 Healthcare clients are looking to add a Retention Specialist to their growing team in Poughkeepsie, NY. This is a contract to hire opportunity with the potential for growth!
· Analyze reports Claims denials, front-end rejects, denials reason codes to determine appropriateness and areas of intervention.
· Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
· Analyze daily call contact reports to determine accuracy, follow up, time frames and possible disenrollment threats.
· Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
· Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
· Communicate findings to Operations. Marketing. Quality etc.. to facilitate the creation of needed job aides. areas of training. member material updates. newsletter updates. etc.
· Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
· Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
· Analyze grievance report data to determine trends. updated training needs. adherence to State reporting guidelines. and communications
· 3+ years of experience in managed care or health plan focusing on claims processing. reimbursement methodologies and charge systems
· 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
· Other Government programs experience (Medicare and Medicaid) Preferred