Claims Expert

We are seeking a highly skilled Claims Analyst to join our team at Carle Health in Urbana, IL. This is a great opportunity for individuals who enjoy working with numbers and have excellent analytical skills.

The Claims Analyst will be responsible for accurately processing medical, dental, orthodontia, and pharmacy claims for timely payment to providers and members. They will interpret and apply various provider reimbursement methodologies, benefit plan designs, employer/member contracts, and Medicare pricing methodologies.

• Adjudicate claims at a high level of productivity and accuracy as measured by individual weekly performance audits.
• Prioritize, manage, and balance workload daily utilizing pended claim reports, paper claim sorting, and balancing to ensure performance guarantees are met and payment of interest is avoided.
• Correspond with providers and members by letter and phone on occasion to notify them of claim denials or missing information.
• Research and analyze miscellaneous document submissions to effectively determine the course of action and impact on pended or finalized claims.

To be successful in this role, you should have one year of experience in medical claims adjudication, healthcare billing, or healthcare customer service. You should also have knowledge of medical, dental, and pharmacy benefits; medical and dental terminology; provider contracting; Medicare reimbursement methodologies; Explanation of Benefits; familiarization with healthcare coding requirements (ICD-9, ICD-10, CPT, CDT, HCPCS) and legislation; and claim billing forms (CMS1500, UB04, dental claim form, as well as electronic billing formats).

We offer a competitive salary range of $55,000 - $65,000 per annum, depending on experience. Our benefits package includes health insurance, retirement savings plan, paid time off, and opportunities for professional growth and development.

Carle Health is a leading healthcare system in central Illinois, providing quality care to our patients and community. We value diversity, equity, and inclusion and strive to create a workplace culture that promotes these values. If you are passionate about delivering exceptional patient care and committed to excellence, we encourage you to apply for this exciting opportunity.