The Claims Research Analyst I reviews and monitors adjudicated claims for file submission and upstream processing and communicates with provider agencies on claims submission, denial management, and system updates. This position is also a primary communication point for providers experiencing an array of claims difficulties. This position serves to provide excellent customer service to provider agencies.
This is full-time onsite position. The selected candidate must reside in North Carolina.
Responsibilities and Duties
Process Claims
- Review, monitor, and adjudicate claims
- Review patient and provider account updates in MCS and re-adjudicate claims as appropriate; including for retroactive Medicaid coverage, retroactive authorizations, provider contract updates, clinician credentialing updates
Manage Phone Queue
- Manage phone queue for general calls
- Communicate with provider agencies on claims submission, denial management, and system updates
Communication
- Maintain consistent and timely communication
Minimum Requirements
High School diploma or equivalent and two (2) years of related experience
Or
Bachelor’s degree in a related field and a minimum of one (1) year of related experience
Preferred- Bachelor’s degree
Knowledge, Skills, and Abilities
- Knowledge and experience with healthcare claims processing, common claim denials and sources for correction
- Knowledge of healthcare services and medical coding
- Knowledge of Microsoft Office Suite, including intermediate Excel, Word, Outlook
- Excellent customer service skills
- Written and oral communication skills sufficient for the sharing of technical information
- Skill in using techniques to research and analyze claims data
- Ability to set objectives and prioritize workflow
- Ability to adhere to department policies, procedures, and general practices
- Knowledge of various software to include an AR system, UltraEdit, NC Tracks, and Claims Systems
- Skill in organizing
Salary Range
$18.19 to $31.32/Hourly
Exact compensation will be determined based on the candidate’s education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
- 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