About the role

  • Review and monitor adjudicated claims for file submission and upstream processing
  • Communicate with provider agencies on claims submission, denial management, and system updates
  • Facilitate training of providers and provide intermediate technical assistance
  • Analyze available billing requirements, policies, procedures, and desk references to ensure proper protocol is practiced to accurately process claims
  • Demonstrate and utilize advanced analytical skills to process complex claims
  • Monitor and resolve technical issues within the Claims system
  • Communicate and conduct liaison work across multiple departments to resolve claims denials/issues
  • Provide training, education, and technical assistance to provider agencies

Requirements

  • High School degree or equivalent and four (4) years of related experience (in customer service, claims processing, research/analytics, or communications)
  • Or Bachelor’s degree from an accredited college or university in related field and two (2) years of experience (in customer service, claims processing, research/analytics, or communications)
  • Knowledge of Microsoft Office, including Excel, Word, Outlook
  • Working knowledge of healthcare services and systems
  • Working knowledge of functions provided by Provider Networks, Utilization Management, Accounts Payable, Contracts, and Care Management
  • Knowledge of common claims denials and sources for correction
  • Knowledge of Medicaid and IPRS rules
  • Knowledge of laws, legal codes, precedents, government regulations, and MCO policies and procedures
  • Knowledge of medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations
  • Excellent customer service skills
  • Proficiency in written and oral communication

Benefits

  • Medical
  • Dental
  • Vision
  • Life
  • Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

Job title

Claims Research Analyst

Job type

Experience level

Mid levelSenior

Salary

$23 - $29 per hour

Degree requirement

High School Diploma

Location requirements

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