Claims Analyst I (Remote-NC) at Partners Behavioral Health Management

Gastonia, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Mar, 26

Salary

0.0

Posted On

09 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Adjudication, Customer Service, Compliance, Quality Assurance, Medicaid Waiver Requirements, HCPCS, Revenue Codes, ICD-10, CMS 1500, UB04 Coding, Organizational Skills, Communication Skills, Microsoft Office, Data Entry, Integrity, Confidentiality

Industry

Hospitals and Health Care

Description

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 any of Partners' NC locations 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 and Experience Preferred: N/A Licensure/Certification Requirements: N/A

Responsibilities

The Claims Analyst I is responsible for ensuring timely and accurate payment to providers through claims adjudication and customer service. The role also involves compliance and quality assurance tasks to maintain standards and improve processes.