Address
Form of work
SalaryPosition 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
