DOFR Specialist

You have a minimum of 5 years of experience in the US Healthcare industry. Your expertise includes: - Claims processing - Medical Billing experience in Medicare or commercial line - Experience in Contract configuration, with specific knowledge on Division of Financial responsibility work - Strong knowledge of Managed Care, specifically Medicare Advantage, Commercial, or Medi-cal - Ability to translate agreements/contracts into a matrix for codification - Contract interpretation - Understanding of financial responsibility related to healthcare (Division of Financial Responsibility) - Understanding of contracting - Extensive understanding of billing including service code, rev code, diagnosis, and place of service - Translation of health plan financial responsibility to code set level - Coding experience - Experience in claims processing Your role will require you to apply your in-depth knowledge and experience in US Healthcare to ensure efficient claims processing and accurate medical billing. Additionally, your familiarity with Managed Care and contract configuration will be essential in interpreting and translating agreements for effective codification.,