CommuniCare Health Services is currently recruiting for the position of Claims Business Analyst for our Medicare Advantage plan!
This is a fully remote position.
PURPOSE/BELIEF STATEMENT
The position of Business Analyst (Claims) reports directly to Director of Operations with strong collaborative relationships with Appeals, Provider Relations and Contracting, and external vendors to ensure adhesion to Medicare claim processing requirements and payment requirements.
WHAT WE OFFER
As a CommuniCare employee you will enjoy competitive wages and PTO plans.
We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers.
We also offer 401(k) with employer match and Flexible Spending Accounts.
QUALIFICATIONS & EXPERIENCE REQUIREMENTS Bachelor's degree in business, health care administration, or similar; or at least 2 years of experience working in health insurance field2 years of experience with government health insurance (Medicare, Medicare Advantage, Medicaid) preferredHealth insurance plan claim processing experience (adjudication, audit, review)Claim appeal experience preferredSQL familiarity and ability to run basic queries with interest in learning moreExcellent time management skills including prioritization and preparednessExcellent communication skills, both verbal and writtenExceptional attention to detail and ability to meet all required deadlinesAbility to multi-task and adapt to changing prioritiesProficient typing skills, ability to work in Office applications and program software programs KNOWLEDGE/SKILLS/ABILITIES Expert level Excel experienceMust have Medicare regulatory knowledgeMust be flexible, able to work independently, and able to achieve deadlines and deliverables with minimal supervision.Must have ability to work effectively with people coming from diverse cultural and professional perspectives. JOB DUTIES & RESPONSIBILITIES Effectively review and audit medical claims, identify inaccuracies in processing, perform root cause analysis, and provide input on solutionsMonitor claims trends to ensure timely identification of configuration and payment errorsAnalyze report results, pinpoint trends and correlations in complicated data sets utilizing Excel and SQLResearch and interpret Medicare claim processing regulations and requirementsResearch and respond to claim questions from various business areas (Appeals, Provider Relations, Providers)Develop automated and re-useable routines for extracting claims dataAssist with CMS regulatory reporting Qualified candidates, apply now for a chance to join our outstanding team!
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