Claims Analyst - Claims Processor REMOTE
Claims Analyst - Claims Processor REMOTE
Posted on :
10-04-2025
Employer Active
1 Vacancy
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Share
Send me jobs like this
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Job Description
We are currently hiring aREMOTEClaims Analyst! If you are a knowledgeable passionate detailoriented individual with healthcare billing experience and value being part of a team that makes a difference you may be the right person for the position!Apply today!
JOB SPECIFICATIONS
Classification:NONEXEMPT Status & Schedule:FULLTIME MONDAY FRIDAY 8AM 5PM
Location:REMOTE
Location:REMOTE
Work Location:OR CA AZ MO TX FL AL
Salary:$18.0426.22/ HOURLY
Department:Claims Reports to:CLAIMS MANAGER Supervision Exercised:NONSUPERVISORY
Salary:$18.0426.22/ HOURLY
Department:Claims Reports to:CLAIMS MANAGER Supervision Exercised:NONSUPERVISORY
Job Purpose: Healthcare Claims Analyst
This position is responsible for the review and analysis of medical claims for accuracy and completeness and the adjudication of claims using the appropriate contract benefits. This position also responds to incoming provider inquiries in a professional timely manner.
Qualifications Education & Experience
This position must have the ability to remain in a stationary position occasionally move about inside the office to access office machinery printer etc. frequently communicate and exchange accurate information.
Work Condition: Remote
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of DOCS Management Services employees. Other duties responsibilities and activities may change or be assigned at any time with or without notice.
This position is responsible for the review and analysis of medical claims for accuracy and completeness and the adjudication of claims using the appropriate contract benefits. This position also responds to incoming provider inquiries in a professional timely manner.
Qualifications Education & Experience
- High school diploma or GED equivalent required
- Knowledge of facility and professional pricing methodologies like DRG case rate per diem of billed fee schedules etc. is required.
- Three years of experience with healthcare claims billing or adjudication experience preferred
- Experience with inpatient and outpatient facility billing (UB04/837I) preferred
- Coding and billing certification strongly preferred (CPC CPB COC CIC CCS CCA)
- Will give preference to certified applicants or applicants who are currently obtaining certification.
- Understand Oregon Health Plan benefits company policies and Plexis Quantum Choice claims payment program
- Process institutional and professional claims utilizing CMS pricer Visium Encoder Pro and knowledge of payment methodologies (DRG APC ASC SNFRUG etc)
- Answer inbound calls and respond to provider inquiries about claim status and adjudication
- Adjust claim payments when necessary
- Apply guidelines for surgical centers CPT codes HCPCS REV codes ICD10 NCCI Edits National Drug Code and other code sets
- Analyze and adjudicate claims in line with Health Plan Contract and company policies
- Pay pend or deny claims based on eligibility referral/prior authorization COB medical review and claims policy
- Research and review claims that need additional data coordinating with billing offices as required
- Deliver exceptional customer service addressing plan coverage and payment inquiries
- Ensure timely response to inquiries document interactions and conduct necessary research
- Identify and correct errors handle overpayments and issue refund requests
- Maintain comprehensive documentation of claim decisions via phone email fax and courier
- Crosstrain in various department functions to enhance efficiency
- Participate in quality and organizational process improvement activities and teams as requested
- Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
- Handle confidential information and materials appropriately and maintain a secure work area
- Perform other assigned duties
- Participate in quality and organizational process improvement activities when requested
- Support and contribute to effective safety quality and risk management efforts by adhering to established policies and procedures maintaining a safe environment promoting accident prevention and identifying and reporting potential liabilities
- Openly clearly and respectfully share and receive information opinions concerns and feedback in a supportive manner
- Work collaboratively by mentoring new and existing coworkers building bridges and creating rapport with team members across the organization
- Provide excellent customer service to all internal and external customers which includes team members members students visitors and vendors by consistently exceeding the customers expectations
- Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
- Advance personal knowledge base by pursuing continuing education to enhance professional competence
- Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
- Represent organization at meetings and conferences as applicable
- Comprehensive knowledge of medical claims Oregon Health Plan eligibility data elements and relevant coding systems and code sets (CPT HCPCS ICD10 National Drug Code etc)
- Indepth knowledge of facility claims billing and reimbursement methodologies for various healthcare settings (inpatient outpatient skilled nursing facilities ESRD facilities home health hospice)
- Familiarity with the components of DRG pricing (DSH IME DME etc.
- Proficiency in medical terminology
- Utilization of fee schedules and designated resources including the Oregon Health Authority Prioritized List Centers for Medicare and Medicaid Services (CMS) Oregon Health Authority (OHA) and DOCS Management Services guidelines and apply those resources to accurately process claims
- Comprehensive grasp of company policies procedures and transactional payment systems
- Strong problemsolving abilities including identifying issues recommending solutions and organizing and analyzing information
- Attention to detail and organizational skills for accurate processing
- Critical attention to detail for accuracy and timeliness
- Ability to report to work as scheduled and willingness to work a flexible schedule when needed
- Proficient in Microsoft Office Suite and Windows Operating System (OS)
- Training in or awareness of Health Literacy Poverty Informed Systemic Oppression language access and the use of healthcare interpreters uses of data to drive health equity Cultural Awareness TraumaInformed Care Adverse Childhood Experiences (ACEs) Culturally and Linguistically Appropriate Service (CLAS) Standards and universal access
- Knowledge and understanding of how the positions responsibilities contribute to the department and company goals and mission
- Knowledge of federal and state laws including OSHA HIPAA Waste Fraud and Abuse
- Awareness and understanding of equity diversity inclusion and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social political and environmental contexts of policies programs and practices
- Excellent people skills and friendly demeanor
- Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems
- Attention to detail and organization skills
- Ability to handle stress and sensitive situations effectively while projecting a professional attitude
- Ability to communicate professionally both conversing and written
- Ability to work with diverse populations and interact with people of differing personalities and backgrounds
- Sensitive to economic considerations human needs and aware of how ones actions may affect others
- Ability to organize and work in a sensitive manner with people from other cultures
- Poised; maintains composure and sense of purpose
This position must have the ability to remain in a stationary position occasionally move about inside the office to access office machinery printer etc. frequently communicate and exchange accurate information.
Work Condition: Remote
- Employee generally works within a remote work from home environment.
- Travel may be required on occasion.
- Hours of operations and specific staff scheduling may vary based on operational need.
- Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
- Machines equipment tools and supplies used: Constantly operates a computer or other office productivity machinery or software such as fax copier calculator multiline telephone system or scanner.
- May answer a high volume of telephone calls complete documentation and use computer programs to either obtain or record information.
- Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of DOCS Management Services employees. Other duties responsibilities and activities may change or be assigned at any time with or without notice.
Required Experience:
IC
Employment Type
Full Time
Report This Job
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.
