Claims Management Analyst

County of Mecklenburg, NC•Charlotte, NC

9d•$63,080 - $82,792

About The Position

Performs research and analysis for claims management within the finance department. This position works independently and is responsible for managing projects, advising management on results and recommending necessary adjustments to department procedures. The successful candidate will have knowledge of revenue cycle principles as well as federal, state, and local healthcare coding and billing rules and regulations.

Requirements

Minimum of two years’ experience in a related field.
Bachelor’s degree in Business Administration, Public Administration, Data Analytics or a related field.
May require a valid North Carolina or South Carolina Driver’s License
May require County Driving Privileges
Knowledge of Accounting principles
Knowledge of Medical terminology, ICD-10, CPT, and HCPCS codes
Knowledge of Principles and processes for providing customer and personal services; this includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction
Knowledge of Business and management principles involved in strategic planning, project management, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources
Knowledge of Structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
Skills in Data management and data visualization
Skills in Understanding written sentences and paragraphs in work related documents
Skills in Talking to others to convey information effectively
Skills in Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
Skills in Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions
Abilities in Job / Organizational Fit: The extent to which activities and responsibilities available in the job are consistent with the activities and responsibilities that result in personal satisfaction; the degree to which the work itself is personally satisfying; the extent to which an organization’s mode of operation and values are consistent with the type of environment that provides personal satisfaction.
Abilities in Technical / Professional Knowledge & Skills: Having achieved a satisfactory level of technical and professional skill or knowledge in position-related areas; keeping up with current developments and trends in areas of expertise
Abilities in Managing Work: Effectively managing one’s time and resources to ensure that work is completed efficiently
Abilities in Building Strategic Relationships: Developing and using collaborative relationships to facilitate the accomplishment of work goals
Abilities in Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements or cultures
Abilities in Information Monitoring: Setting up ongoing procedures to collect and review information needed to manage an organization or ongoing activities within it
Abilities in Collaboration: Working effectively and cooperatively with others; establishing and maintaining good working relationships
Abilities in Active Listening: Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate
Advanced proficiency in various computer applications including Microsoft Office Suite

Nice To Haves

Master’s degree in Business Administration, Public Administration, Data Analysis or a related field.
Certified Professional Coder (CPC) certification from AAPC

Responsibilities

Analyze claim data to ensure proper reimbursement and advises management of results
Monitor and analyze all referred accounts to determine categorization, level of the appeal process, and personally handle complex appeal responses for private health care, government-specific denials, and recommend necessary adjustments to department procedures
Work under the guidance of department management on strategic projects to include assisting in the establishment of goals and objectives
Respond to requests from State, County, local municipality government, external partners such as payers, external clinicians or community stakeholders
Manage various projects aligned with Strategic Business Plan goals
Gather and organize information about the problem to be solved or the procedure to be improved
Meet with program leaders and conduct on-site observations to develop training materials implement quality assurance processes, and to serve as a resource to internal departments, financial institutions, and external agencies
Analyze financial and other data; including, but not limited to, revenue, expenditure, and insurance payer reports
Develop solutions or alternative practices
Recommend new systems, procedures, or organizational changes
Make recommendations to management through presentations or written reports
Confer with managers to ensure that the changes are successfully implemented and creating positive results