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Claims Analyst I
2 months ago
Competitive Compensation & Benefits Package
Position eligible for –
Annual incentive bonus plan
Medical, dental, and vision insurance with low deductible/low cost health plan
Generous vacation and sick time accrual
12 paid holidays
State Retirement (pension plan)
401(k) Plan with employer match
Company paid life and disability insurance
Wellness Programs
See attachment for additional details.
Office Location:
Remote; Available for any of our office locations (as needed)
Work Hours :
Monday - Friday; 8 am - 5 pm
Projected Hiring Range : Depending on Experience
Closing Date :
Open Until Filled
Primary Purpose of Position:
This position is responsible for ensuring that providers receive timely and accurate payment.
Role and Responsibilities:
50%: Claims Adjudication
Responsible for finalizing claims processed for payment and maintaining claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines.
Responsible for reconciling provider claims payments through quality control measures, generally accepted accounting principles and agency’s policies and procedures.
Assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and will coordinate the recoupment process to ensure payment is recovered for inappropriately paid claims.
Provide back up for other Claims Analyst in their absence.
40%: Customer Service
Maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interacting in a professional manner; providing information and assistance; and answering incoming calls.
Assist providers in resolving problem claims and system training issues.
Serve as a resource for internal staff to resolve eligibility issues, authorization, overpayments, recoupments or other provider issues related to claims payment.
10%: Compliance and Quality Assurance
Review internal bulletins, forms, appropriate manuals and make applicable revisions
Review fee schedules to ensure compliance with established procedures and processes.
Attend and participate in workshops and training sessions to improve/enhance technical competence .
Knowledge, Skills and Abilities:
Working knowledge of the Medicaid Waiver requirements, HCPCS, revenue codes, ICD-10, CMS 1500/UB04 coding, compliance and software requirements used to adjudicate claims
General knowledge of office procedures and methods
Strong organizational skills
Excellent oral and written communication skills with the ability to understand oral and written instructions
Excellent computer skills including use of Microsoft Office products
Ability to handle large volume of work and to manage a desk with multiple priorities
Ability to work in a team atmosphere and in cooperation with others and be accountable for results
Ability to read printed words and numbers rapidly and accurately
Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules
Ability to manage and uphold integrity and confidentiality of sensitive data
Education and Experience Required:
High School graduate or equivalent and three (3) years of experience in claims reimbursement in a healthcare setting; or an equivalent combination of education and experience.
Licensure/Certification Requirements:
NA
Work Schedule: Monday– Friday, 8am – 5pm
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