Job Overview - Government
The Claims Analyst – Government is responsible for entering claims and answering provider-related claims inquiries. The Claims Analyst must be familiar with each plan’s plan benefit package as well as standard CMS guidelines. Specific responsibilities of the Claims Analyst include but are not limited to:
Job Overview - Commercial
The Claims Analyst – Commercial is responsible for answering provider-related claims inquiries, benefits, eligibility as well as authorization requirements. The Claims Analyst must be familiar with each plan’s plan benefit package as well as standard commercial guidelines. Specific responsibilities of the Claims Analyst include but are not limited to:
Responsibilities for both roles
- Determine the status of medical claims through research.
- Reviewing charges and member eligibility, explaining denial codes and plan benefits using established guidelines and standards.
- Follow-up on provider calls on status, explanation of payment, billing errors, and refund requests.
- Assists providers with interpreting claims EOPs and answering claims-related questions.
- Providing timely filing and appeal guidelines based on Medicare guidance.
- Maintain accurate and current activity reports and records for reporting to executive management.
- Comply with all regulatory requirements.
Qualifications for both roles
- 5 or more years of experience working in a healthcare claims environment.
- EDI processing experience preferred.
- Strong Knowledge of Medicare, Medicaid, and private insurance claims processing.
- Knowledge of Medicare Advantage and Medicaid programs.
- Excellent conflict resolution skills.
- Strong written communication skills.
- Knowledge of health plan technology challenges.
- Proficiency in MS Office Suite.
ADDITIONAL NOTES
Must possess a valid driver's license.
Travel is required occasionally
Job Type: Full-time
Benefits:
- 401(k)
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Customer service: 5 years (Required)
- Reviewing and Analyzing Medical Claims: 5 years (Preferred)
- Interpreting Explanation of Payment and Claim Denials: 2 years (Preferred)
- Medicare Claims: 1 year (Preferred)
Ability to Commute:
- Little Rock, AR 72201 (Required)
Work Location: In person
