Medicaid Senior Claims Analyst

Network Health; Menasha, Midway Place (WI, LA); Hybrid; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a Senior Claims Analyst to join their team in enhancing the health and wellness of their clients. This role involves complex claim adjudication, training new staff, and ensuring compliance with organizational policies. The ideal candidate will possess strong communication and organizational skills, along with a solid understanding of CPT and ICD-10 coding. With flexible work options available, including remote and hybrid models, this position offers a unique opportunity to contribute to a mission-driven organization while maintaining a healthy work-life balance. If you have a passion for customer service and a keen eye for detail, this role is perfect for you.

Qualifications

• 3-5 years of claims processing experience required.
• Knowledge of federal and state mandates related to claims preferred.

Responsibilities

• Resolve customer issues and inquiries professionally and promptly.
• Assist in training new staff members and monitor claims reports.
• Collaborate with senior management on system limitations.

Skills

CPT coding

ICD-10 coding

Communication skills

Organizational skills

Problem-solving skills

Attention to detail

Customer service

Education

High School Diploma

Coursework in Medical Terminology

Tools

Microsoft Word

Microsoft Excel

Job description

Network Health Senior Claims Analyst Job Description

Network Health's success is rooted in its mission to enhance the life, health, and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. We are seeking a Senior Claims Analyst responsible for complex claim adjudication, training, development, and process documentation within the department.

Essential Job Duties:

1. Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health.
2. Apply organizational, regulatory, and credentialing principles, procedures, requirements, and policies appropriately.
3. Resolve customer issues and inquiries professionally and promptly.
4. Assist in training new staff members.
5. Run reports to retrieve processing information from the claims processing system.
6. Collaborate with senior management and the operations team regarding system limitations and testing issues.
7. Identify and troubleshoot claims issues.
8. Assist Claims Management with projects, work production, claims adjustment reports, and prioritization of activities to meet team and department goals.
9. Act as a liaison with other operational departments on workflow, processing, and system opportunities.
10. Maintain and update guidelines.
11. Monitor suspended claims reports to ensure time frames are met.
12. Perform other duties as assigned.

Knowledge, Skills, and Abilities:

1. Strong oral and written communication skills, with the ability to listen attentively, identify gaps, and ask appropriate questions.
2. Organizational skills to manage work and space effectively to complete tasks within deadlines.
3. Adaptability to new circumstances, information, and challenges in a fast-paced environment.
4. Ability to work independently and as part of a team.
5. Knowledge of CPT and ICD-10 coding.
6. Understanding of medical terminology and COB processing.
7. Basic proficiency in Word and Excel.
8. Excellent critical thinking, problem-solving, and decision-making skills.
9. Attention to detail and follow-through.
10. Strong commitment to customer service for internal and external clients.

Minimum Education Requirements:

• High School Diploma or equivalent.
• Additional coursework in Medical Terminology or Advanced Medical Terminology.
• Knowledge of federal and state mandates related to claims and coding is preferred.

Experience:

• 3-5 years of claims processing experience.

Additional Information:

Candidates must reside in Wisconsin. The position offers flexible work options, including remote work with reliable internet, in-office at Brookfield or Menasha, or a hybrid model.

We are an Equal Opportunity Employer committed to a diverse workforce. Applicants will be notified of their rights under federal employment laws. For more information, review the Know Your Rights notice from the Department of Labor.