Professional Reimbursement Consultant - (Naperville, IL)

Description: BASIC FUNCTION: This position is responsible for 1 or more of the following: developing and implementing new/existing provider types; specialty contracts; reimbursement mechanisms; new/existing provider networks; coordinating and implementing correct claims adjudication or claim auditing logic of provider types; identifying/investigating potential fraud operations and coordinating with Special Investigations Department; acting as Provider Affairs liaison between internal operating areas and the provider community; and providing education/training to the provider community. POSITION QUALIFICATIONS: *Bachelor Degree or current R.N. license for state. *seven years background in healthcare industry working with claims adjudication logic (Blue Chip) and payment structures. *Verbal and written correspondence skills; analytical, quantitative and decision making skills. PREFERRED POSITION QUALIFICATIONS: *PC proficiency to include Access, Microsoft excel and PowerPoint