3 Analyst, Claims (Remote) Jobs in Phoenix, AZ
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Tango is Hiring a Remote Analyst, Claims (Remote)
Brief DescriptionThe Claims Analyst is accountable for and oversees the following tasks:
- Processes all “unclean” claims adhering to claims policies and procedures
- Confirm reimbursement accuracy upon approving per the Provider Contracts or SCA/LOA agreements on file when processing claims
- Analyze claims EOB pend/denial codes and troubleshoot why claim was unclean and collaborate with Claims Customer Service Analysts to educate the provider on claims submission errors
- Perform claims reprocessing as assigned
- Assist with special reports of processing claim reports and fixing eligibility and authorization mismatches accurately and timely
- Apply knowledge of coding in order to determine if claim should be denied or approved per claims policies
- Review documentation, analyze submitted claims data with an average of 95% accuracy monthly
- Escalate any system issues or roadblocks that prevent hitting claim metrics as applicable
- Processing claims within the Claims Policies at 95% accuracy and meeting productivity standards as outlined
- Thorough Knowledge of EOB denial/pend codes, HIPPS, HCPCS and DX codes in order to process claims within regulations.
- Escalating all Provider Claim issues and systemic errors to ensure positive rapport with our network Providers in accordance with tango Claims Policies and Procedures
- 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.
- Knowledge of Medicaid EVV verification process required for accurate claims processing.
- Knowledge of PDGM reimbursement processing for Medicare claims.
- Knowledge of authorization process for accurate claims processing.
- Good communication skills and team player.
- Familiarity with EDI claims/ claims submission related to CMS requirements.
- Other duties as assigned.
- 2 ~ 4 years of direct experience minimum in Claims Adjudication and Clearinghouse submissions/rejections
- Basic Knowledge/understanding of Medicare/Medicaid claims processing and CMS regulations
- Detailed knowledge of medical coding; HIPPS, CPT and HCPCS codes
- Solid understanding of eligibility as well as claims paying for all lines of business
- 4~6 years’ work experience that provides a working knowledge of billing and delinquency procedures
- Beginner level Microsoft Office skills (PowerPoint, Word, Outlook)
- Beginner level Microsoft Excel skills
- Analytical, research, problem solving, and decision-making skills
- Full time
Job Summary
JOB TYPE
Full Time
INDUSTRY
Retail
SALARY
$62k-79k (estimate)
POST DATE
08/23/2024
EXPIRATION DATE
09/19/2024
HEADQUARTERS
AUCKLAND, AUCKLAND
SIZE
<25
FOUNDED
2004
CEO
MELANIE DOWLING
REVENUE
<$5M
INDUSTRY
Retail
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