Claims Analyst - Government

About This Role

Determining the status of medical claims through research and answering provider-related inquiries are the core tasks for this government claims analyst. The role involves reviewing charges, explaining denial codes and plan benefits, and assisting providers with interpreting claims EOPs. This position suits an individual familiar with plan benefit packages and standard CMS guidelines.

Responsibilities

• Determine the status of medical claims through research
• Review charges and member eligibility, explaining denial codes and plan benefits using established guidelines and standards
• Follow-up on provider calls regarding status, explanation of payment, billing errors, and refund requests
• Assist providers with interpreting claims EOPs and answering claims-related questions
• Provide timely filing and appeal guidelines based on Medicare guidance
• Maintain accurate and current activity reports and records for reporting to executive management
• Comply with all regulatory requirements

Requirements

• 5 or more years of experience working in a healthcare claims environment
• Strong knowledge of Medicare, Medicaid, and private insurance claims processing
• Knowledge of Medicare Advantage and Medicaid programs
• Excellent conflict resolution skills
• Strong written communication skills
• Knowledge of health plan technology challenges
• Proficiency in MS Office Suite

Nice to have:

• EDI processing experience

Benefits

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Important Details

• Schedule: 40.0 hours per week

Relocation Support

• Relocate to Little Rock, AR 72201 before starting work