Analyst, Configuration Oversight - Audit on transplant claims

JOB DESCRIPTION Job Summary Provides analyst support for configuration oversight activities. Responsible for accurate and timely implementation and maintenance of critical information on claims/provider databases, validating data housed on databases and ensuring adherence to business and system requirements of customers as it pertains to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. Facilitates end-to-end claim audits, maintains audit records, provides counsel regarding coverage amount/benefit interpretation within the audit process, monitors and controls backlog and workflow of audits, and ensures that audits are completed in a timely fashion and in accordance with audit standards. This role will focus on auditing claims on transplants. Essential Job Duties • Analyzes and interprets data to determine accurate/appropriate configuration. • Accurately interprets s...