Healthcare Subject Matter Expert I at Karna
Healthcare Subject Matter Expert I
- Job ID2020-2228
- Job Locations
The Healthcare Subject Matter Expert I will work in support of the World Trade Center Health Program (WTCHP) client providing expert support, education and knowledge to Internal and External contracted providers, Clinical Centers of Excellence (CCE ) staff, Karna staff/ colleagues, and others as required.
- Provides expert support, analysis and research into complex problems and processes relating to the World Trade Center Health Program (WTCHP)
- Responsible for educating new providers on all WTCHP policies and procedures
- Responsible for researching and answering provider inquires regarding Fee Schedules and/ or Reimbursement
- Works closely with other department staff and escalates issues as needed to senior level SME
- Works with CCE Case Managers to assist with referrals to network providers (assists in locating the closest provider based on specialty and where patient resides/ works)
- Provider and CCE Outreach to include, but not limited to, the following:
- Obtain updated demographic information when RAs are returned due to invalid addresses
- Clarify vendor NPI setups
- Validate incorrect NPIs
- Gather information about incorrect claims payments
- Obtain updated EFTs when payment transactions fail due to invalid bank account information
- Processes provider information into the autoload template to send to claims subcontractor for entry into their claims system and portal
- Other duties as assigned
- Requires at least five (5) years of relevant experience
- Bachelors degree or equivalent
- Well-versed in Microsoft Office products to include Word, Excel, PowerPoint and Outlook.
- Previous experience working with the World Trade Center Health Program is preferred
- Knowledge of various provider reimbursement types to include FECA, DRG, Cost to Charge Ratio (CCR) is required
- Strong verbal and written communication skills and the ability to interact effectively with a diverse group of staff, both internal and external, and providers.
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