Claims Analyst
November 20
Description
• Ensure the accuracy, timeliness, and compliance of healthcare claims data • Monitor and manage encounter data submissions, resolving data issues • Coordinate with internal and external stakeholders to maintain efficient claims processing • Analyze encounter data submission to identify potential issues and trends • Coordinate and perform corrections to data rejections to ensure timely resubmission • Monitor EDI file transfers to identify and resolve issues with automated processes • Facilitate daily, weekly, and monthly file transfers for CCO business operations and vendor support • Collaborate with OHA and other partners to implement changes in EDI file transfers • Assist with EOCCOs annual External Quality Reviews and Information System Capability Assessments • Prepare monthly reports for Finance from GOBHI’s data warehouse • Respond to ad-hoc data requests from Finance, UM, and other internal departments • Maintain strong relationships with internal and external stakeholders, including members, partners, and vendors • Serve as a resource for GOBHI staff and contracted providers on behavioral health coding and claims processing
Requirements
• Two years experience in healthcare claims processing, healthcare billing, data analysis, or similar related field • Experience with EDI file transfers (837, 834 processes), encounter data, and behavioral health coding (CPT, HCPCS, ICD-10) preferred • Excellent verbal and written communication skills • Strong analytical and problem-solving skills • Proficiency in MS Office Suite and Google Workspace • Experience with SQL, PostgreSQL, and/or database management • Project management skills • High attention to detail and organizational abilities • Ability to work independently and as part of a team • Flexibility to adapt to changing priorities and deadlines • Knowledge of healthcare claims processing, coding, and regulatory requirements
Benefits
• Competitive salary – starting at $62,000.00 annually • Additional bilingual compensation available • Medical, dental and vision insurance for you and dependents • Generous paid time off • Company paid life and long-term disability insurances • EAP • FSA, with a $500 employer contribution • Triple AAA insurance • Mileage reimbursement • Wellness benefits • 401k contribution, including 6.5% employer contributions • Cell phone and internet reimbursements
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