Claims Analyst

Community Behavioral Health.•Philadelphia, PA

1d•$0 - $55,000

About The Position

The Claims Analyst will ensure accurate, timely processing and payment of claims. Claims Analyst resolve any claims issues and serve as a liaison for CBH providers for all claims matters.

Requirements

Bachelor’s degree preferred or minimum of 5 years of claims experience.
Minimum of 3 years of experience, preferably in claims and/or customer service role.
Understanding of EDI and TPL is preferred.
Proficiency in Word, Excel and Powerpoint.
Proficiency in working with Claims and Clinical Databases.
Strong Analytical skills.
Effective interpersonal and customer service skills.
Strong organizations skills.
Ability to multi-task in a fast-paced environment.
Must be a current Philadelphia resident or become a resident within six months of hire.
Must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Nice To Haves

Understanding of EDI and TPL is preferred.

Responsibilities

Review claims to ensure accurate processing.
Handle both TPL and non-TPL institutional and professional claims.
Serve as a liaison for providers regarding payment issues.
Utilize knowledge of billing codes, BHSRCC, CBH Business Rules and Contracts to review claims/encounters.
Ensure compliance with financial and regulatory guidelines.
Complete claims appeals, claims adjustments, and member eligibility discrepancies.
Train providers on claims processes and procedures.
Troubleshoot provider issues and address internal claims questions.
Answer phone calls and emails from providers within 24 to 48 hours.
Review and analyze claims data using multiple applications.
Multitask and aggregate claims data.
Complete claims reversal/reprocessing, appeal, eligibility discrepancies, and Business Rule requests.
Create tickets via JIRA/Freshworks to track issues.
Review claims data and provide comprehensive analysis to providers.
Report out the status of assigned providers.
Maintain overall knowledge of assigned providers' claims issues and claim history.
Work with other departments within Community Behavioral Health (i.e. Program Integrity, Contracting, Clinical and Provider Operations) to resolve claims/encounter issues.
Provide technical assistance to providers by training, weekly claim review meetings and developing reports.
Review encounters to resolve any issues.
Work with Business Rules Management Team on addressing encounter errors.
Perform extensive research, follow up with providers, create tickets for tracking and work within other CBH departments to resolve issues.
Perform administrative duties such as facing, mailing, scanning, emailing, copying, filing and other duties assigned by management.