Responsible for conducting data analysis to identify aberrant claim submission patterns and to evaluate red flag reports. Assist in initiation and implementation of special investigations through management of provider record receipt and preparation, mail merge projects, reviewing and responding to provider communications, and preparing internal and external reports. Assist in development of reporting database to track and report on cases.
Specific Skills Needed: Working knowledge of advanced MS Access and Excel functions, software applications (SAP), and query reporting. Strong oral and written communication skills, critical thinking, data analytics, and organizational skills.