4 Analyst, Claims Customer Service (Remote) Jobs in Phoenix, AZ
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Analyst, Claims Customer Service (Remote)
$65k-80k (estimate)
Full Time | Retail
1 Month Ago
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Tango is Hiring a Remote Analyst, Claims Customer Service (Remote)
Brief DescriptionThe Claims Customer Service Analyst is accountable for and oversees the following tasks:
- Manage all claims appeals, including disputes, redeterminations, and reconsiderations
- Confirm reimbursement accuracy and work with Networks, Medicaid, and Medicare in any questions/concerns
- Analyze claims activity and work reports received by Providers, Networks or Management
- Perform claims reprocessing, reexporting and address medical billing issues
- Assist with special reports of tracking problems with medical claims according to HIPPA guidelines, contracts, fee schedules and provide education to providers/internal staff as applicable
- Apply knowledge of coding to determine if dispute is valid
- Review documentation, analyze reject claim data, justify CPT & HCPCS codes and pay HCFA-1500 and UB92 claims.
- Take inbound customer-service calls and make outbound calls to providers
- Investigate pending claims and resolve discrepancies
- Explains EDI claims transmissions and educates providers on rejection reasons and how to resolve the issue to ensure clean claim submissions
- Contacts providers to provide necessary billing guidelines to comply with quality and process standards
- Follows established guidelines specific to each claim report or inquiry
- Review, coordinate and respond to all request or record requests in a timely order
- Responsible for delivery of EOP’s to providers after each claim run
- Responsible for investigating clearinghouse rejections, ensuring rejection letters are accurate and of high quality
- Responsible for collaborating with Networks on escalating all high-volume rejection/denial claims by provider as communicated in Bi-weekly Claim Dashboards and providing an improvement plan on submission of clean claims for timely payments
- Take part in the monthly Claim Webinar Training to our Network
- Oversees review of claims inventory for quality and findings in external audits from all Payors/Providers as well as annual internal audit in accordance with tango Claims Policies and Procedures
- Handling of all claim escalations (verbal and electronic) in accordance with tango Claims Policies and Procedures
- Escalating all high-volume Provider Claim issues to ensure positive rapport with our network Providers in accordance with tango Claims Policies and Procedures
- Mentoring new team members and providing assistance and review of quality of work during onboarding
- Perform other duties as assigned within the scope of responsibilities and requirements of the job
- Performs the essential functions of this job with or without reasonable accommodation
- 5 to 7 years of direct experience minimum in Claims Adjudication and Clearinghouse submissions/rejections (required)
- Advanced level of skills and knowledge of technical system operations (required)
- Detailed knowledge of medical coding; HIPPS, CPT and HCPCS codes
- Solid understanding of enrollment and eligibility as well as claims paying for all lines of business
- Solid understanding of claim data sets required on Encounter Files to ensure resubmission of claims/disputes are in accordance to 837 CMS regulations
- 1-3 years working in a claims inbound call center (required)
- Professional level training that provides a general understanding of:
- Administration of all contractual obligations
- Audit and billing procedures
- Policies and procedures
- Processing of accounts receivable and eligibility requirements impacts claims processing
- Vendor data feeds and discrepancy process
- Administrative and regulatory requirements
- Technical workflow processes
- Functional requirements of the system
- Solution design documents.
- 4 to 6 years work experience that provides a working knowledge of:
- Billing and delinquency procedures
- Accounts receivable process
- System testing and enhancement process
- Web portal data support
- Advanced level Microsoft Office skills (PowerPoint, Word, Outlook)
- Advanced level Microsoft Excel skills
- Advanced level of Web Reports and how to read 837 files to support working of encounter rejections
- Interpersonal, communication (written and verbal) and presentation skills
- Analytical, research, problem solving, and decision-making skills
- Ability to monitor team goals
- Ability to lead and coach team members
- Full-time
Job Summary
JOB TYPE
Full Time
INDUSTRY
Retail
SALARY
$65k-80k (estimate)
POST DATE
08/15/2024
EXPIRATION DATE
09/12/2024
HEADQUARTERS
AUCKLAND, AUCKLAND
SIZE
<25
FOUNDED
2004
CEO
MELANIE DOWLING
REVENUE
<$5M
INDUSTRY
Retail
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