Claims Analyst I (Monday-Friday; Remote)
Monroe, NC Monroe, NC Full-time Full-time $36,506 - $44,329 a year $36,506 - $44,329 a year 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.
Estimated Salary: $20 to $28 per hour based on qualifications.
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.
Estimated Salary: $20 to $28 per hour based on qualifications.
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