Medical Claims Analyst Claims Processor REMOTE

Coos Bay, OR - USA

Hourly Salary: $ 18 - 26

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

We are currently hiring aREMOTEClaims Analyst! If you are a knowledgeable passionate detail-oriented 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:NON-EXEMPT Status & Schedule:FULL-TIME MONDAY FRIDAY 8AM 5PM
Location:REMOTE

Work Location:OR CA AZ TX FL
Salary:$18.04-26.22/ HOURLY
Department:Claims Reports to:CLAIMS MANAGER Supervision Exercised:NON-SUPERVISORY

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

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.

Essential Responsibilities: Claims Adjudication

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 SNF-RUG 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 ICD-10 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
Cross-train 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

Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER

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 co-workers 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

Knowledge Skills & Abilities:

Comprehensive knowledge of medical claims Oregon Health Plan eligibility data elements and relevant coding systems and code sets (CPT HCPCS ICD-10 National Drug Code etc)
In-depth 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 problem-solving 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 Trauma-Informed 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

Working Conditions:
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.

Exposed to:

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 multi-line 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.

Other Information:
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: