Remote Reinsurance Analyst: Medicaid/Medicare Claims

Blue Cross Blue Shield of Arizona; Phoenix (AZ); À distance; USD 65 000 - 90 000; Plein temps

Résumé du poste

Blue Cross Blue Shield of Arizona is hiring a Recoveries Analyst to drive Medicaid/Medicare reinsurance recovery and lead Level 2 responsibilities. The role covers transplant and catastrophic reinsurance cases, coordination with Claims and Accounting, and ensuring timely AHCCCS compliance.

The position requires a strong background in health plan reinsurance, claims processing, and related software tools, with hybrid/remote work options within Arizona.

Qualifications

• 2 years of experience in health plan reinsurance or claims unit or AHCCCS administration (Level 1)
• 3 years of experience in health plan reinsurance or claims unit or AHCCCS administration (Level 2)
• High School Diploma or GED
• Bachelor’s degree in accounting, business or related field of study

Responsabilités

• 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 coordinating 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.
• Coordinate with Claims department to ensure proper processing of all Medicaid reinsurance claims.
• Ensure all reinsurance claims/CRN are encountered and associated 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 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 and leadership within the team.

Connaissances

Reinsurance knowledge

Claims processing

AHCCCS familiarity

Formation

High School Diploma or GED

Bachelor’s degree in accounting, business or related field

Outils

PMMIS

Excel

QNXT

MedMc

Oracle

Description du poste

Blue Cross Blue Shield of Arizona is hiring a Recoveries Analyst to drive Medicaid/Medicare reinsurance recovery and lead Level 2 responsibilities. The role covers transplant and catastrophic reinsurance cases, coordination with Claims and Accounting, and ensuring timely AHCCCS compliance.

The position requires a strong background in health plan reinsurance, claims processing, and related software tools, with hybrid/remote work options within Arizona.