Partners Health Management

Claims Analyst I (Monday-Friday; Remote)

Partners Health Management Kannapolis, NC

Partners Health Management

Claims Analyst I (Monday-Friday; Remote)

Partners Health Management Kannapolis, NC
4 months ago 38 applicants

See who Partners Health Management has hired for this role

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

See attachment for additional details.

Office Location: Remote; Available for any of our office locations (as needed)

Work Hours : Monday - Friday; 8 am - 5 pm

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 Analyst in their absence.

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.

Licensure/Certification Requirements

NA

Work Schedule: Monday– Friday, 8am – 5pm

  • Seniority level

    Mid-Senior level

  • Employment type

    Full-time

  • Job function

    Finance and Sales

  • Industries

    Hospitals and Health Care

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