Claims Analyst I (Remote Option)

Partners Health Management; Gastonia (NC); Remote; USD 51,000 - 84,000; Full time

Job summary

A leading healthcare organization is looking for a Claims Analyst I with remote options to ensure accurate and timely claims processing. The role involves responsibilities in claims adjudication and providing exceptional customer service to providers, requiring strong communication and organizational skills.

Benefits

Annual incentive bonus plan

Medical, dental, and vision insurance

Generous vacation and sick time accrual

12 paid holidays

401(k) Plan with employer match

Wellness Programs

Company paid life and disability insurance

Qualifications

• Three years of experience in claims reimbursement in a healthcare setting required.
• Ability to manage a desk with multiple priorities.

Responsibilities

• Finalizing claims processed for payment and ensuring timely payment.
• Providing customer service to handle provider inquiries and resolve claims issues.

Skills

Organizational skills

Communication skills

Computer skills

Education

High School graduate or equivalent

Job description

Join to apply for the Claims Analyst I (Remote Option) role at Partners Health Management

Join to apply for the Claims Analyst I (Remote Option) role at Partners Health Management

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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
  
  

See attachment for additional details.

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

• 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.
  
  

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.

Education andExperience Preferred: N/A

Licensure/Certification Requirements: N/A

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Hospitals and Health Care

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