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Partners Health Management · 1 month ago

Claims Analyst I (Remote-NC)

United States

Full-time

Remote

Mid Level

3+ years exp

Partners Health Management is a healthcare organization focused on ensuring accurate and timely claims payments. The Claims Analyst I position is responsible for claims adjudication, customer service, and compliance, ensuring provider satisfaction and adherence to payment guidelines.

FitnessHealth CareMedical

Work & Life Balance

Responsibilities

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 Analysts as needed

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

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

Qualification

Medicaid Waiver knowledgeICD-10 codingClaims adjudicationMicrosoft Office proficiencyData entry accuracyOrganizational skillsCommunication skillsTeam collaboration

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

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