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Claims analyst

1 month ago

Indianapolis, United States State of Indiana Full time

Role Overview:

The Medicare Claims Analyst will serve as the primary subject matter expert for the Indiana Health Coverage Programs (IHCP) claims reimbursement function related to Medicare Claims and Managed Care Encounter Claims. They will be responsible for auditing claims files and resolving any issues related to Medicare and Managed Care Encounter claims. The ideal candidate should have a Bachelor’s degree with a minimum of five years of healthcare claims experience, Medicare Claims experience required. This candidate would have extensive experience in data analysis, medical claim billing with a significant emphasis on working with coordination of benefits (COB), plus a working knowledge of coverage for members with dual eligibility both Medicare and Medicaid. Salary Statement:

The annual salary for this position traditionally starts at $67,314.00 but may be commensurate with education or work experience. A Day in the Life:

The essential functions of this role are as follows: Establish, monitor, and implement long-range objectives and specifying the strategies, KPIs, and actions to achieve them. Analyze operations to evaluate performance of the specific program or its staff in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy change. Interpret and explain in-depth and complex policies, rules, regulations, or laws to organizations, government or corporate officials, or individuals. Develop and implement corrective action plans to solve organizational or departmental problems. Prepare and present reports for approval, including those for funding or implementation of services to executive leadership. Develop and oversee program financial or budget activities to fund operations, maximize investments, or increase efficiency. Develop and monitor program requirements to ensure it meets federal and state policies and grants compliance. Develop and supervise training of employees and consultants on program requirements and usage. Develop, coordinator, and deliver communication plans and communications. Preside over, or serve on, boards of directors, management committees, or other governing boards. Recruit, select, onboard, and train employees to ensure role responsibilities and expectations are clearly understood while providing opportunities to continue professional development. Set expectations, measure progress, provide ongoing feedback, and evaluate the performance of employees. Ensure work adheres to quality standards, deadlines, and proper procedures. The job profile is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice. What You'll Need for Success:

The ideal candidate in this role should minimally have either a Master’s Degree and 5+ years of experience, or a Bachelor’s Degree and 7+ years of experience, or an Associate’s Degree and 9+ years of experience, or at least 11+ years of experience applying the below, outlined knowledge, skills, and abilities in a similar role. You must meet the following requirements to be considered for employment: Mastery knowledge in program subject matter obtained through experience and/or education. Broad knowledge of provider agencies and their programs and services. Broad knowledge of all source materials and references including federal and state laws governing the programs. Ability to adapt new statues and guidelines to create and implement new principles and policies and discern any far-reaching implications. Ability to present and represent the agency to both internal and external customers, the public, government officials, and other stakeholders. Analyzing information and evaluating results to choose the best solution and solve problems. Ability to work effectively with a wide variety of stakeholders. Ability to analyze and prepare monthly finance and accounting reports to maintain program budget and grants. Ability to delegate work, set clear direction, and manage workflow. Ability to effectively give feedback, provide guidance or corrective action, coach, and develop employee skillsets. Supervisory Responsibilities/Direct Reports:

This role may serve as a team lead for an assigned work group. Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefit package for full-time employees which includes: Three (3) medical plan options (including RX coverage) as well as vision and dental plans Wellness Rewards Program: Complete wellness activities to earn gift card rewards Health savings account, which includes bi-weekly state contribution Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities Deferred compensation 457B account (similar to 401k plan) with employer match Two (2) fully-funded pension plan options A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:

150 hours of paid new parent leave Up to 15 hours of paid community service leave

Combined 180 hours of paid vacation, personal, and sick leave time off 12 paid holidays, 14 on election years Education Reimbursement Program Group life insurance Referral Bonus program Employee assistance program that allows for covered behavioral health visits Qualified employer for the Public Service Loan Forgiveness Program Free Parking for most positions Free LinkedIn Learning access Equal Employment Opportunity: The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Our policy is to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, creed, religion, sex, national origin, ancestry, age, sexual orientation, gender identity, physical or mental disability, or veteran status. We will comply with the spirit as well as the letter of all applicable state and federal laws. If you are a qualified individual with a disability and require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at jobs@spd.IN.gov. The State of Indiana has established a culture that welcomes equity, inclusion, and opportunity for all employees and applicants. We encourage you to apply if you feel you have the transferrable skills to be successful in this position and we look forward to reviewing your application.

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