Clinical Billing and Claims Analyst

6 days ago

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Modivcare

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Modivcare is a company that focuses on simplifying the experience of living with complex healthcare needs by providing a comprehensive suite of supportive care solutions. They specialize in non-emergency medical transportation, personal care, and virtual & remote patient monitoring. Modivcare works closely with Medicaid Plans, State Agencies, Medicare Advantage, SNP Plans, health systems, healthcare professionals, and transportation providers, ensuring that members receive necessary health services. Through innovative technology and data-driven strategies, they address social determinants of health by offering services like quality transportation, chronic care management, meal delivery, and in-home assistance, aimed at optimizing patients' health outcomes and improving their overall experience.

remote patient monitoring • personal care services • non-emergency medical transportation • NEMT • nutritious meals

10,000+ employees

Founded 2017

⚕️ Healthcare Insurance

🚗 Transport

🔥 Funding within the last year

💰 $525M Post-IPO Debt on 2024-07

📋 Description

• Responsible for processing and managing claims, supporting operational improvements in revenue cycle processes, and ensuring accurate and timely client invoicing. • Handles claim documentation, analyzes complex revenue data, conducts insurance eligibility checks, and collaborates with multiple departments to enhance billing accuracy and compliance. • Involves reconciling accounts, auditing internal controls, and providing leadership in project work as needed. • Review and process claims to ensure documentation is complete and accurate. • Conduct monthly and ongoing insurance eligibility checks for all program members to support accurate claims and billing. • Ensure timely, accurate invoicing and participate in accounts receivable collection efforts. • Perform account reconciliations to resolve discrepancies, and maintain documentation of internal controls, ensuring SOX compliance where applicable. • Identify and implement process enhancements, and contribute to system modifications. • Report suspected fraudulent claims to appropriate departments and ensure compliance with policies. • Work closely with internal departments, providers, and clients to gather information, resolve claim and billing inquiries, and improve customer service. • Lead projects related to claims and billing improvements, facilitate workgroup meetings, and oversee complex software implementations. • Occasional business travel may be required.

🎯 Requirements

• Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field preferred. • Three (3) plus years of experience in claims processing, billing, or a related role within a healthcare or data-driven environment. • Strong analytical and problem-solving skills, with the ability to interpret and manage large datasets effectively. • Advanced proficiency in Microsoft Excel (e.g., pivot tables, formulas, v-lookups) and experience with SQL or other data analysis tools. • Deep understanding of healthcare billing standards, insurance claims processing, and compliance regulations (SOX preferred). • Strong attention to detail and ability to conduct thorough audits, reconciliations, and fraud detection reviews. • Effective project management skills, with the ability to lead initiatives, oversee software implementations, and drive process improvements. • Excellent verbal and written communication skills, capable of engaging with internal teams, clients, and external stakeholders. • Ability to work independently and make data-driven decisions, ensuring compliance with company policies and industry regulations. • Strong organizational and time management skills, capable of handling multiple priorities in a fast-paced environment. • Customer-focused mindset, with the ability to resolve claims and billing inquiries efficiently and professionally. • High level of learning agility and adaptability, with a proactive approach to staying updated on industry changes and process improvements. • Strong collaboration and teamwork skills, fostering positive working relationships across departments.

🏖️ Benefits

• Medical, Dental, and Vision insurance • Employer Paid Basic Life Insurance and AD&D • Voluntary Life Insurance (Employee/Spouse/Child) • Health Care and Dependent Care Flexible Spending Accounts • Pre-Tax and Post --Tax Commuter and Parking Benefits • 401(k) Retirement Savings Plan with Company Match • Paid Time Off • Paid Parental Leave • Short-Term and Long-Term Disability • Tuition Reimbursement • Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)