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The Allianz LifeTrac Transplant Network is a national network of over 40 of the world's leading transplant facilities that perform solid organ and bone marrow transplants, and is the only network of its kind accredited by JCAHO, Accessible to over 23 million lives nationwide, LifeTrac serves over 400 HMOs, PPOs, TPAs, major insurance companies and employer health plans.
POSITION PURPOSE:
This position serves as an internal and external technical resource, providing guidance and support on the development and maintenance of our electronic claims repricing system, offering recommendations on LifeTrac's claims processes and procedures, and developing and administering a claims quality assurance program.
POSITION RESPONSIBILITIES:
- Primary contact with our claims repricing vendor and coordinating activities related to maintenance of the claims repricing system.
- Develop and administer a quality assurance program.
- Act as a technical resource to staff.
- Make recommendations about internal claims processes and procedures.
- Establish LifeTrac's coding guidelines for facilities and provider groups.
- Participate in client implementation education.
- Work with clients and providers to facilitate the resolution of complex complaints and appeals.
- Participate in the development of payment language in provider contracts.
- Analyze and reprice complex transplant claims as needed. | 