Healthcare Subject Matter Expert I at Karna

Remote
Karna

Healthcare Subject Matter Expert I

  • Job ID2020-2228
  • Job Locations
    • US-Remote
  • Category
    • Other
  • Type
    • Full-Time/Regular

Overview

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.

Responsibilities

  • 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

Qualifications

  • 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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