The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents and health plan members, and we will take care of the rest!
Process par reconsideration requests and non par reimbursement disputes in order to ensure requests are finalized within the established regulatory and contracted time frames. Investigation and analysis of par reconsideration requests to include: Reimbursement disputes, coding issues, benefit issues and medical necessity denials. Investigate claims issues received by Regulatory Compliance regarding Department of Insurance (DOI), Centers for Medicare & Medicaid (CMS), Attorney General (AG) and any other regulatory agency. Assists Supervisor with audits and monitoring of Par Reconsideration activity.