Job details

Medical Claims Analyst/Specialist-Remote

Overview:

Join our team as a Claims Analyst/Specialist

This opportunity is open to remote applicants in the United States, with the exception of the following states:

Washington, Wyoming, North Dakota, and Ohio. Must be able to work mountain time

Responsible for monitoring all research functions within the Claims Department. This includes researching all written and verbal inquiries from members and providers, handling complaints and acting as a liaison to providers for special claims handling

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days

Qualifications:

Claims Analyst -High School education (G. E. D.) required. One year office/business experience, or is currently in a position demonstrating customer service skills. Data entry experience and typing speed of 45 words per minutes preferred . Required demonstrated ability to work effectively with co-workers. Knowledge of ICD10, CPT coding, and/or HCPCS preferred. Demonstrated ability to communicate effectively in person, via telephone and in writing.

Claims Specialist - High School plus specialized, short-term training in claims processing. Minimum three years experience in medical claims processing. Demonstrated ability to communicate effectively in person, via telephone and in writing

Education:
Essential:

High School Diploma or GED

Competencies and skills:
Nonessential:

SKILL-Ability to effectively interact with customers to understand their needs and explain data
SKILL-Microsoft Office
Planning and coordinating organizational change
Anticipating & Addressing Customer Needs
Functioning as an Effective Contingent Member
Acquiring & Applying Superior Skills to achieve Quality Outcomes
Functioning as an Effective Team Member
SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
SKILL-Written communication

Responsibilities:

Processes and adjusts inpatient and outpatient medical claims according to departmental quality and production standards.

Pends claims as directed by departmental policies and procedures, follows up for resolution, and processes pended claims immediately following a benefit/payment determination.

Identifies patterns in resubmitted and adjusted claims. Identifies errors and inconsistencies that require revisions to claim guidelines or system modifications

Ability to process claims requiring special handling, (i.e. Case Management, Transplants, Negotiations and processes coordination of benefits (COB) as required.

Uses online policies and procedures to ensure accurate and consistent processing of claims.

Performs follow up and takes all necessary actions required to resolve all errors and findings assessed by the Internal Audit department.

Benefits:

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/employee-benefits/Pages/default.aspx

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Minimum Offer: USD $15.00/Hr. Maximum Offer: USD $18.00/Hr.