Claims Analyst ; Remote-NC

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.

Remote Option;
Available for any of Partners' NC locations

Depending on Experience

Open Until Filled

This position is responsible for ensuring that providers receive timely and accurate payment.

• 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, over payments, 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.

• 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

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.

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