Alliance Health

Analyst

• Supports policy analysis, writing and research activities
• Identifies, obtains, organizes and analyzes data
• Reviews academic and professional literature
• Assists in reviewing state developed clinical coverage policies
• Develops and implements adequate work plans for project improvement activities
• Serves as a resource for medical policy-related questions
• Acts as the department liaison with the internal Communication team

Clinical Planning and Policy Analyst

Research Analyst

• Review and monitor adjudicated claims for file submission and upstream processing
• Communicate with provider agencies on claims submission, denial management, and system updates
• Provide excellent customer service to provider agencies
• Facilitate training of providers and provide intermediate technical assistance
• Review auto-adjudicated claims and manually process claims that pend for manual pricing or high impact criteria
• Analyze available billing requirements, policies, procedures, and desk references to ensure proper protocol is practiced to accurately process claims
• Demonstrate and utilize advanced analytical skills to process complex claims, analyze data, identify system issues, and utilize/build reports to enhance overall unit performance
• Aid in the leadership of the unit through facilitation of meetings, trainings, and process improvement efforts
• Communicate across all departments including Utilization Management, Provider Networks, Finance (Purchasing, Accounts Payable, Accounting), Care Management
• Communicate with external stakeholders including DHHS, DSS, DHB, provider agencies, third-party vendors, and other Managed Care Organizations
• Monitor and resolve technical issues within the Claims system
• Create reports to monitor status of billing, including: paid and denied provider claims; unmanaged and managed service utilization, and consumer or payer-specific reports on claims reimbursement or adjudication

Clinical Planning and Policy Analyst

Claims Research Analyst