Lead Claims Analyst
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Job Description
Lead Claims Analyst coordinating claims processing and support for national health organization. Overseeing claims quality, training staff, and resolving complex issues in a remote role.
Responsibilities:
- Assist in coordinating the day-to-day work function of the assigned claims unit
- Provide technical support to staff
- Investigate, review and resolve complex issues
- Provide oversight to ensure payments and/or denials are made in accordance with company practices and procedures
- Ensure Claims Analysts apply policy and provider contract provisions to determine claim payability
- Train, mentor and develop claims analysts as reinforcement of claims training
- Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims
- Serve as first point of escalation
- Monitor claims quality reviews for accuracy, document results and identify trends
- Assist in creating workflows for the department
- Primary contact for the team, for the plan and for other departments
- Maintain appropriate records, files, documentation, etc.
- Meet and maintain department production and quality standards
Requirements:
- High school diploma or equivalent
- Associate degree or equivalent experience preferred
- 2+ years of claims processing required
- Experience with Medicaid, Marketplace, or Medicare claims required
- Experience using computers and advanced skills in Microsoft Office (Word, Excel, etc.) required
- Ability to perform math functions and reason logically
- Knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology required
- Must have successfully completed claims basic training, COB advanced training, and ramp period.
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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