Senior Claims Analyst
3 weeks ago
Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative,consumer-centric health benefit solutions that people can actually use.Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
As Gravie looks to continue its member-centric approach to healthcare, the
Senior Claims Analyst
will support, review and adjudicate claims in our best in class claim system. The Senior Claims Analyst will be a subject matter expert capable of thoroughly evaluating, researching, and analyzing claim submissions with a solid knowledge of national claims guidelines. In addition to personally reviewing complex claims, the Senior Claims Analyst will play a key role in elevating the performance of the team, assisting in training, serving as a resource to other Examiners, and pitching in as needed with special projects. The Senior Claims Analyst will also support leadership with inventory management, process development, auditing, and other tasks as assigned.
You will:
· Support team discussions, aid in team claims issue resolution efficiently, and lead by example.
· Accurately review, investigate and confirm coverage to appropriately process medical claims and identify key components of processing requirements based on contracts, policies and procedures
· Support team in testing claims and system configurations.
· Play a key role in helping develop team members to perform at their highest level by offering coaching opportunities, sharing expertise and best practices, offering on the spot feedback and celebrating achievements.
· Examine and confirm coverage to appropriately process medical claims and identify key components of processing requirements based on contracts, policies and procedures.
· Review claims queues and provide expertise to address nuances with appropriate parties.
· Assist with periodic claims and process auditing to improve department outcomes.
· Continually meet department metrics and qualityset forth by leadership.
· Play a key role in the development of departmental workflows and procedures.
· Facilitate the department specific training and continuation of education training.
· Collaborate with QA team to determine necessary updates to department processes and procedures to improve departmental quality and efficiency.
· Work with leadership to monitor and report on KPI data.
· Communicate complex claims issues clearly through documentation and direct communications.
· Ability to utilize multiple applications to fulfill all job functions.
You bring:
· High School Diploma
· 5 + years of experience processing/adjusting and/or analyzing medical claims preferably in a TPA environment.
· Strong knowledge of CPT/HCPC and ICD-10 code rules.
· Previous experience using Javelina processing system.
· Ability to set priorities, manage time and work independently.
· Basic proficiency using Windows based other computer applications.
· Functional comfort with Zoom, Microsoft Teams, or Google Meets
· General knowledge of CMS claims submission regulations
· Demonstrated success getting results through collaboration.
· Excellent facilitation and transferable knowledge skills communicating effectively on complex concepts.
· Proven ability to develop and implement medical claims processes.
· Experience in managing and assigning claims inventory.
Extra credit:
· Medical Coding experience/certification
· Medical Billing experience
· Understanding of provider data
· Previous start-up company experience
· Degree in Healthcare Administration or similar field
· Training and ability to create processes/procedure documentation is a plus.
Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.
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