Claims Research & Resolution Professional

The Claims Research & Resolution Professional will track and trend Michigan Medicaid claims data, conduct root cause analyses of claims denials, rework, underpayments, and errors. They will support the Provider Relations team by providing guidance on claims submission processes, coding updates, and common billing errors to reduce denials and ensure accurate payments. This role involves minimizing claims recoupments, conducting training on claims issues, assisting with claims submission expectations, and identifying recurring issues for improvement. The professional will escalate internal system issues, contribute to billing forums, and partner with internal teams to resolve provider inquiries and issues, ensuring compliance with Managed Care contract requirements and optimizing provider satisfaction. They will also submit and monitor business case justifications and incorrect payment audit requests, and assist with the development of provider communications and educational materials.