Medical Claims Analyst - Licensed Cpc, Cpc-P, Cpc-H

We have a nice full-time opportunity for an experiencedMedical Claims Analyst at a premier company in Grand Rapids, Michigan. The Medical Claims Analyst assists members and clients with disputes, questions, and interpretation of insurance plan documents, plan descriptions, and processing claims. Candidates with CPC, CPC-P, and CPC-H licenses are preferred. This is an onsite-only position.

Claims Functions

• Medical /HRA/HSA/Dental/Vision/Flex/STD self-insured claims processing.
• Benefit interpretation of a Summary Plan Description and a Plan Document.
• Knowledge of the vendor role (PBMs, PPOs, Case Management) concerning claims functions.
• Adhere to claims processes and procedures.
• Effectively adjudicate claims and meet quantity and quality standards
• Processing all types (i.e., Coordination of Benefits, Office, Hospital) of claims while meeting department turnaround time standards.

Customer Service Functions:

• Develop and strengthen relationships with members and clients through phone contact and call resolution.
• Effectively utilize all customer service tools available.
• Review and respond to verbal member and provider disputes.
• Take an active role in Claims and Customer Service Meetings.
• Answer calls from clients and/or members inquiring about their claims and healthcare coverage.

Qualifications Required

• 2-4 years working as a Medical Claims Analyst
• Ability to create new or modify existing Microsoft Word and Excel reports and documents.
• Superior communication skills, both verbal and written.
• 3-5 years of experience in the healthcare field would require knowledge of medical and billing terminology.
• Familiarity with CPT/ICD-10 codes, standard health claim billing forms (UB and HCFA)
• Experience processing all types of claims, such as COB, Medicare, dental, vision, medical, etc., etc.
• Professional conduct at all times with an emphasis on superior customer service.
• Excellent attendance record
• Able to work within a team environment and assist co-workers when needed.

Education and/or Experience**

• Associate's Degree or a combination of education and experience.
• 2- 4 years experience as a Medical Claims Analyst, not a medical billing clerk
• Minimum 2 years experience within a call center where customer service and the overall member experience were a priority.
• Knowledge of trends and regulations that impact the healthcare industry.
• Knowledge of the Coordination of Benefits and Medicare is preferred.

License:

• CPC, CPC-P, CPC-H (Preferred)

Job Type: Full-time

Salary: $21.00 - $25.00 per hour

Benefits:

• Health insurance

Schedule:

• 8-hour shift
• Day shift
• Monday to Friday

Work setting:

• Clinic
• Office

Ability to Relocate:

• Grand Rapids, MI: Relocate before starting work (Required)

Work Location: In person