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  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI, USA
    Req #1052
    Friday, May 8, 2020
    JOB SUMMARY: Conduct complex, in-depth analysis of claim payments and its methodology, identifying trends and patterns, to ascertain cost avoidance/overpayment recovery opportunities. Apply root cause analysis to design and develop solutions to payment integrity opportunities/issues, and coordinate implementation efforts with internal stakeholders as well as vendor(s) and providers as applicable. Ensure medical claims, records and other documentation essential to claims submission and reimburse ... More