Reinsurance Analyst - Remote in AZ

Blue Cross Blue Shield of Arizona; United States; Remoto; USD 60.000 - 90.000; Tempo pieno

Descrizione del lavoro

Blue Cross Blue Shield of Arizona is seeking a Recoveries Analyst to support Medicaid reinsurance activities. The role focuses on researching and reviewing claims, coordinating with AHCCCS, and leading daily and senior-level tasks within the Recoveries Department.

Two levels (Level 1 and Level 2) describe responsibilities from assisting with routine processes to leading in transplant and catastrophic reinsurance cases, with emphasis on accuracy and timely reimbursement.

Competenze

• Required High School Diploma or GED; preferred bachelor’s in accounting, business or related field.
• Experience with health plan reinsurance, AHCCCS administration or claims units.
• Knowledge of AHCCCS guidelines and Medicaid reinsurance requirements.
• Proficiency with PMMIS, MedMc and QNXT systems and basic SQL.

Mansioni

• Assist in day-to-day reinsurance dept tasks; identify and manage transplant and catastrophic reinsurance claims with AHCCCS coordination.
• Process and balance encounters; ensure timely submissions and reimbursements per AHCCCS rules.
• Prepare and review reinsurance reports; support accounting and data warehouse reconciliation.
• Lead by example, motivate teams, and promote process improvements.

Conoscenze

PowerPoint

Word

Excel

Communication

Analytical thinking

Team player

Formazione

High School Diploma or GED

Bachelor’s degree in accounting, business or related field

Strumenti

PMMIS

MedMc

QNXT

SQL (Beginner)

Descrizione del lavoro

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This position is Remote within the state of AZ only. This Remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the job

The Recoveries Analyst’s primary line of business is Medicaid. Primary purpose of the Analyst is to research and review all claims and use best practices in the recovery of any eligible stop-loss reimbursement. (Level 1)

The Recoveries Department Sr serves as the department lead for both the Medicare and Medicaid reinsurance lines of business. Provides support to the Reinsurance manager by taking the lead in all managerial functions, as in hosting meetings, reporting data and adding unification within all areas of the company. Primary purpose of the Sr is to provide leadership and educate best practices in the recovery of any eligible stop-loss reimbursement. (Level 2)

Qualifications

• Required Work Experience: 2 years of experience in health plan reinsurance or claims unit or AHCCCS administration (Level 1)
• Required Work Experience: 3 years of experience in health plan reinsurance or claims unit or AHCCCS administration (Level 2)
• Required Education: High School Diploma or GED
• Required Licenses: N/A
• Required Certifications: N/A
• Preferred Work Experience: N/A
• Preferred Education: Bachelor’s degree in accounting, business or related field of study
• Preferred Licenses: N/A
• Preferred Certifications: N/A

Essential job functions and responsibilities

• Level 1 Assist in the day-to-day activities for the reinsurance department. Identify and manage Transplant Reinsurance claims/cases in a timely and efficient manner by: In coordination with Medical Service’s transplant coordinator to create and maintain transplant cases and stages with AHCCCS Review transplant log to ensure all cases are created and monitor stage and component payment. Transplant reinsurance cases are entered and maintained in PMMIS and encounters are tracked and balanced against PMMIS screen RI113 to ensure proper balancing prior to component submission. Identify and manage Catastrophic Reinsurance claims/cases in a timely and efficient manner by: Submit Annual Catastrophic reinsurance renewal letters to AHCCCS Medical Management within 30 days of the beginning of each contract year to ensure timely creation of Catastrophic Reinsurance cases Coordinate with Claims department to ensure proper processing of all Medicaid reinsurance claims. Ensure all reinsurance claims/CRN are encountered and associating according to AHCCCS or Medicaid Business Segment’s rates Adhere to AHCCCS timely filing limits to ensure proper reimbursement. Review AHCCCS reinsurance reports (Case Summary, Remittance Advice, Case Initiation and Case Reconciliation) monthly to ensure proper reinsurance reimburse. Work directly with Accounting and Data Warehouse to maintain accurate Medicaid reinsurance reconciliation. Maintain current working knowledge of AHCCCS reinsurance manual, procedures, and requirements. Review high dollar claims report to ensure all reinsurance is captured. Provide Motivation, encouragement and be a role model to others internal and external of the company.
• Level 2 - SR Assist in the day-to-day activities for the reinsurance department. Identify and manage Transplant Reinsurance claims/cases in a timely and efficient manner by: In coordination with Medical Service’s transplant coordinator to create and maintain transplant cases and stages with AHCCCS Review transplant log to ensure all cases are created and monitor stage and component payment. Transplant reinsurance cases are entered and maintained in PMMIS and encounters are tracked and balanced against PMMIS screen RI113 to ensure proper balancing prior to component submission. Identify and manage Catastrophic Reinsurance claims/cases in a timely and efficient manner by: Submit Annual Catastrophic reinsurance renewal letters to AHCCCS Medical Management within 30 days of the beginning of each contract year to ensure timely creation of Catastrophic Reinsurance cases Coordinate with Claims department to ensure proper processing of all reinsurance claims. Ensure all reinsurance claims/CRN are encountered and associating according to AHCCCS or Medicaid Business Segment’s rates. Adhere to timely filing limits to ensure proper reimbursement. Review AHCCCS reinsurance reports (Case Summary, Remittance Advice, Case Initiation and Case Reconciliation) monthly to ensure proper reinsurance reimburse. Work directly with Accounting and Data Warehouse to maintain accurate reinsurance reconciliation. Maintain current working knowledge of AHCCCS reinsurance manual, procedures, and requirements. Review high dollar claims report to ensure all reinsurance is captured. Provide Motivation, encouragement instruction to subordinates.
• All levels Each progressive level includes the ability to perform the essential functions of any lower levels. Perform all other duties as assigned.

The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

Required Competencies

Knowledge of healthcare and system design (including Oracle); ability to communicate effectively orally and in writing; ability to establish and maintain effective working relationships with others, both within the corporation and externally; knowledge of accounts payable and financial reporting; knowledge in the usage of PowerPoint, Word, and Excel preferred. Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data. Capable of investigative and analytical research. Health plan accounting experience preferred. Knowledge of reinsurance department guidelines, including but not limited to recovery, recoupments, refund posting and COB verification. Knowledge of Medicaid and Medicare coverage and regulations; understanding of Claims Processing; Knowledge of AHCCCS guidelines and reinsurance requirements regarding reinsurance. General knowledge of Excel, Word, Beginner SQL, MedMc, QNXT.

Be a team player and have a drive for process improvement.

Preferred Competencies

None.

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years.