2 jobs found

At NorthBay Health, the Claims Analyst II is responsible for independently completing all tasks in claims adjudication, including processing adjustments. The position is co-responsible for the operational functions for the organization’s capitated hospital and medical group business, processing all claims, oversees customer service issues, researching/resolving payment issues and addressing corrections in the system with the Claims Specialist.    PRIMARY JOB RESPONSIBILITIES Generates Department reports that are utilized weekly by the Claims Specialist position to track timely payment of claims. Oversees the production of encounter data analysis and processing. Lead point of service intake for all claims issues. Claims preparation for determination of payment. Addresses corrections in the claim system and in operational processes. Oversees grievances and provider dispute resolutions in partnership with the Claims...

At NorthBay Health, the Provider Enrollment analyst is responsible for all Medical Staff and Allied Health Practitioner (AHP) heal plan credentialing and recredentialing with government and commercial health plans.  The position is responsible for enrollment, credentialing and termination of NorthBay physicians/providers with NorthBay's contracted health plan partners.  This position maintains rosters and functionality that support a compliant provider enrollment process. Additional role responsibilities include compiling and distributing periodic reports, both within the department and throughout the organization as well as investigating and resolving provider enrollment issues.  Servies as a resource related to the National Committee for Quality Assurance (NCQA). PRIMARY JOB DUTIES Responsible for all enrollment functions, credentialing and termination of providers and select contracted specialists. Serves as a resource...