Partners Health Management
Claims Analyst I (Remote Option)-Gastonia, NC
Partners Health Management, Gastonia, North Carolina, United States, 28054
Claims Analyst I (Remote Option) - Gastonia, NC
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 Public Service Loan Forgiveness Qualifying Employer Office Location:
Remote Option; Available for Gastonia New Hope NC location 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 — Finalize claims processed for payment and maintain claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines. Reconcile provider claims payments through quality control measures, generally accepted accounting principles and agency policies and procedures. Assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and coordinate the recoupment process to ensure payment is recovered for inappropriately paid claims. Provide backup for other Claims Analysts as needed. 40%: Customer Service — Maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interact professionally; provide information and assistance; answer 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. Knowledge, Skills And Abilities Working knowledge of 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. Education and Experience Preferred:
N/A Licensure/Certification Requirements:
N/A Seniority level
Entry level Employment type
Full-time Job function
Finance and Sales Industries: Hospitals and Health Care
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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 Public Service Loan Forgiveness Qualifying Employer Office Location:
Remote Option; Available for Gastonia New Hope NC location 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 — Finalize claims processed for payment and maintain claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines. Reconcile provider claims payments through quality control measures, generally accepted accounting principles and agency policies and procedures. Assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and coordinate the recoupment process to ensure payment is recovered for inappropriately paid claims. Provide backup for other Claims Analysts as needed. 40%: Customer Service — Maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interact professionally; provide information and assistance; answer 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. Knowledge, Skills And Abilities Working knowledge of 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. Education and Experience Preferred:
N/A Licensure/Certification Requirements:
N/A Seniority level
Entry level Employment type
Full-time Job function
Finance and Sales Industries: Hospitals and Health Care
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