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Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! As a Claims Analyst II, you will play a crucial role in processing assigned medical claims that require manual adjudication. This position involves accurately interpreting benefit and policy provisions applicable to the line of business, reviewing claims to determine coverage based on contracts, provider status, and claims processing guidelines. You will be responsible for ensuring that claims are processed in accordance with member plan benefits and department policies and procedures. In this role, you will verify the accuracy of data entry, including patient information, procedure and diagnosis codes, and provider data. You will utilize the Notes system to record pertinent information regarding claims or members and ensure that claims set aside for further action are released in a timely manner. Additionally, you will document issues affecting claims processing quality and provide feedback on standard operating procedures for continual process improvement. You will also assist other internal departments in responding to questions regarding claims processing and provide backup for the Claims Analyst I role. Regular attendance at department meetings and daily team huddles is expected, along with meeting department and company performance and attendance expectations. You will be required to follow PacificSource's privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. This position may also involve performing other duties as assigned.
