Claims Analyst I (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.
• 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