About this role

Achieving resolution of Operational Intakes by the Market Liaison Support Services Research Team
Conduct detailed reviews and document findings
Collaborate with various departments including contracting, credentialing, claims, and IT
Investigate Market State Complaint tasks
Meet Service Level Agreements (SLA)
Generate reports to determine claim impact
Adjust impacted claims and assist in adjudication
Identify opportunities for process improvements
Participate in User Acceptance Training of system issues
Communicate effectively with internal departments
Assist the market proactively by evaluating risks

Bachelor's degree required
Two (2) years of experience in managed care operations required
Knowledge of Medicaid/Medicare
Familiarity with healthcare industry
Understanding of Provider Contracting applications
Advanced troubleshooting and problem-solving capabilities
Overall knowledge of Managed Care Operations-related systems, medical coding, technical specifications, and processes
Solid understanding of claims processing
Proficient in Microsoft Office Suite
Effective organization, time management, and prioritization skills

Market Liaison Resolution Specialist

Key skills