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Claims Analyst

3 months ago

Chicago, Illinois, United States Guidehealth Full time

WHO IS GUIDEHEALTH?


At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers.

As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices prioritizing delivering high-quality healthcare focused on outcomes and value.


Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events.

This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients.

Join us as we put healthcare on a better path


The Claims Analyst role is responsible for claims processing, reviewing, auditing and investigation of high-level coding review and processing discrepancies.

Average number of claims entered weekly , depending on level of difficult claims being worked that week.

WHAT YOU'LL BE DOING

  • HCFA and UB92 Pended Claims and Exception Reports
  • HCFA and UB92 Workflow Queues in Eldorado System
  • Auditing reports such as possible duplicates, timely filing review
  • Working special reports such as Anesthesia, Mental Health, etc.
  • Reviewing and finalizing claims appeals received by providers/members
  • Reviewing Prepayment audit reports
  • Assisting with other coworker's workflow when assigned client based primary responsibilities are caught up.

WHAT YOU'LL NEED TO HAVE

  • High School diploma or equivalent
  • 1 3 years medical claims adjudication experience (HMO claims preferred)
  • Proficiency in Microsoft Office Applications, high Excel proficiency
  • Excellent verbal and written communication skills
  • Good attention to detail and commitment to quality
  • Positive mental attitude

WHAT WE WOULD LOVE FOR YOU TO HAVE

  • Coding certification
  • Experience working in Excel
  • Experience working in Access

COMPENSATION
Guidehealth's compensation structure includes more than just base salary.

We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match.

Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need.


The base pay range for this role is between $21.00 to $23.50 per hour, paid bi-weekly per our standard payroll practices.

Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to:
skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT
Diversity, inclusion, and belonging are at the core of Guidehealth's values. We are an equal opportunity employer.

We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.

Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.


  • This position is responsible for following all Security policies and procedures in order to protect all PHI under Guidehealth's custodianship as well as Guidehealth Intellectual Properties. For any securityspecific roles, the responsibilities would be further defined by the hiring manager._