Claims Analyst (Remote)

REMOTE OR ROCKFORD, IL /VALUE BASED CARE – CLIENT OPERATIONS /FULL-TIME/ REMOTE

Arcadia is dedicated to happier, healthier days for all. We transform diverse data into a unified fabric for health. Our platform delivers actionable insights for our customers to advance care and research, drive strategic growth, and achieve financial success. For more information, visit arcadia.io.

Why This Role Is Important To Arcadia

The Claims Analyst role is responsible for claims processing, reviewing, auditing and investigation of high-level coding review and processing discrepancies. Average number of claims entered weekly 800-1100, depending on level of difficult claims being worked that week.

What Success Looks Like

In 3 months

- Familiar with basic navigation in the Eldorado processing system

- HCFA and UB92 Workflow Queues in Eldorado System

- HCFA and UB92 Pended Claims and Exception Reports

- Auditing weekly reports

- Processing the minimum requirement of 10 claims per hour

In 6 months

- Working special projects

- Familiar with BlueCross portals

- Familiar with internal portals, MCG, Arcadia share point, Appeal Module

- Processing the minimum requirement of 20 claims per hour.

In 12 months

- Assist with other coworker’s workflow when assigned client based primary responsibilities are caught up

- Meeting and maintaining production expectations 23-27 claims per hour on commercial accounts.

- Meeting quality expectations of an average of 95% or higher

- Full understanding of Eldorado system

What You'll Be Doing

• HCFA and UB92 Pended Claims and Exception Reports
• HCFA and UB92 Workflow Queues in Eldorado System
• Audit Reports such as possible duplicates, timely filing review
• Work special reports such as Anesthesia, Mental Health, etc.
• Review and Finalize claims appeals received by providers/members
• Review Pre-payment audit reports
• Assist with other coworker’s workflow when assigned client based primary responsibilities are caught up

What You'll Need to Have

• High School diploma or equivalent
• 1 -3 years medical claims adjudication experience (HMO claims preferred)
• Proficiency in Microsoft Office Applications, high Excel proficiency
• Excellent verbal and written communication skills
• Good attention to detail and commitment to quality
• Positive mental attitude
• Ability to multi-task
• Deadline oriented
• Ability to work independently with minimal supervision

Would Love for You to Have

• Coding certification
• Excel
• Access

What You'll Get

• Join a high performing team who brings all data into one of the top Healthcare Analytics companies in the US
• Receive great health, dental, 401K benefits.
• Work from home opportunities
• Flexible time off 
• Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
• A flexible, remote friendly company with personality and heart
• Employee driven programs and initiatives for personal and professional development
• Be a member of the Arcadian and Barkadian Community

About Arcadia

Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health.  We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website, our online resources, and our interactive Data Gallery.

This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.