Bedford, United States
about 1 year ago
The Investigator is responsible for the analysis, investigation and resolution of provider claim disputes.
Essential Duties and Responsibilities:
Conducts analysis, investigation and resolution of provider disputes
Review, analysis and triage of all cases received.
Responsible for determining the appropriate type of response to a requested dispute.
Must determine deadline dates on all cases and ensure they are met or exceeded.
Prepares all correspondence to gather and investigate a case.
Independently makes decisions about the resolution of their assigned cases.
Produces all documentation to support the decision.
Documents the decision in a resolution letter to the appellant.
Maintains tracking and monitoring information on a database and software used in the department.
Keeps current with all requirements the EVV disputes and processes.
Provides training to peers as necessary in case handling. Enters all job related activities in the applicable database