CLAIMS COORDINATOR
About The Position
As a result of Governor Hutchinson’s Transformation of State Agencies, the Department of Inspector General was created by joining together the Office of Internal Audit, the Fair Housing Commission, and the Office of Medicaid Inspector General. Its mission is to preserve the integrity of State Agencies as well as the Arkansas Medicaid Program and to prevent discriminatory housing and lending practices through investigations, audits, data mining, complaint resolutions, and enforcement of policies and regulation. The Claims Coordinator is responsible for managing and organizing the claims process to ensure accurate, efficient, and timely resolution of insurance claims. This role involves serving as a central point of communication between claimants, insurance providers, and internal teams, as well as maintaining records, monitoring claim statuses, and facilitating resolutions. The Claims Coordinator plays a vital role in streamlining operations and ensuring customer satisfaction by ensuring claims are handled in a professional and compliant manner.
Requirements
- Bachelor’s degree in business administration, insurance, healthcare administration, or a related field.
- Minimum of 4 years of experience in claims coordination, claims management, customer service, or related fields.
Nice To Haves
- Certified Professional Coder
- Knowledge of insurance policies and regulations is advantageous.
Responsibilities
- Analyze diverse data sets for purposes of identifying fraud, waste and abuse in the Medicaid program
- Compare and cross-reference Medicaid claims data with other data sources to identify fraud, waste and abuse
- Perform basic to intermediate claims data analysis, including filtering and aggregating large datasets, identifying trends and outliers, comparing provider billing patterns, calculating financial impacts, and developing audit samples
- Review and analysis of medical records, licensure, employment records, and financial statements
- Evaluate patterns and practices of provider use of CPT, HCPCS, ICD-10-CM, modifiers, units of service, and place of service codes in different program areas to identify potential waste and abuse
- Create spreadsheets, visual data representations, and executive summaries to communicate trends, issues, and data-based conclusions
- Research and identify applicable Arkansas Medicaid policy
- Prepare executive summaries, reports, charts and other materials for communicating results of data analysis in plain language
- Assist with developing new data-driven approaches to identifying and recovering overpayments
- Perform compliance audits as needed
- Coordinate the entire claims process, from initial reporting to resolution, ensuring efficiency and accuracy.
- Serve as the primary liaison between claimants, insurance adjusters, healthcare providers, legal teams, and internal personnel.
- Review and verify claim documentation for completeness and compliance with policy terms.
- Monitor claim statuses and maintain up-to-date records in claims management systems.
- Investigate claim details, identify discrepancies, and resolve issues in collaboration with a variety of assorted personnel.
- Communicate updates and outcomes of claims to relevant parties in a clear and timely manner.
- Assist in developing and implementing process improvements for better claims handling.
- Ensure adherence to agency policies, industry standards, and regulatory requirements.
- Prepare reports and summaries on claims data and trends for management review.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
