The Health Alliance

• Manage employer accounts and associated members’ enrollment or participation in products and services • Comfortable on the phone and email providing cold outreach • Attend and participate in regular reviews with customers • Communicate with program partners to strategize process improvements • Organize and maintain up-to-date patient administrative tasks associated with Pop Health and program databases • Compile quarterly reports for accounts and work with customers on specific reporting requests • Follow up with patients to ensure completion of program processes • Exhibit problem-solving skills to manage questions and requests proactively • Learn quickly and demonstrate task maturity, completing required tasks independently

• Review lab orders and patient records to identify missing or conflicting demographic, insurance, or clinical data • Validate CPT and diagnosis alignment to meet payer medical necessity requirements • Ensure ordering provider information (NPI, credentials, facility details) is complete and accurate • Proactively resolve coverage and data issues before claims are generated • Verify insurance eligibility using 270/271 transactions, payer portals, and integrated tools • Interpret benefits, exclusions, and coordination of benefits that impact reimbursement • Identify and resolve inactive coverage, invalid policy numbers, and payer mismatches • Review claim acknowledgments, clearinghouse reports, and payer responses • Analyze and resolve pre-submission rejections related to formatting, coding, or payer edits • Use TELCOR to review claims, data feeds, file processing issues, and mapping errors • Identify systemic TELCOR issues that cause recurring pre-claim errors • Use SQL to investigate missing data, eligibility mismatches, and payer configuration issues