Medical Claim Analyst

CVS Health

7d•$19 - $35

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Medical Claim Analyst will be part of the Provider Coding and Reimbursement (PCR) team who reviews provider coding and reimbursement denial disputes from providers. This function includes, but is not limited to the following: • Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician. • Prioritize work and be able to multitask to balance projected workload and due dates. • Review provider rework claims in accordance with claim processing and PCR guidelines. • Research claims in the ASD or ACAS/EWM systems. • Research and document claim history in Aetna Strategic Desktop (ASD) and Electronic Correspondence Handling System (ECHS).

Requirements

Ability to review claims
Work within Excel spreadsheets when needed.
Communicate and collaborate effectively with other team members and departments within Aetna.
Work independently and as part of a team.
Prioritize work and be able to multitask to balance project workload and due dates.
Provide excellent service by meeting quality, turnaround key performance metrics, and meeting productivity expectations.

Nice To Haves

Knowledge of functionality in systems including IFP, HRP, etc. for the exchanges support.
Rework experience, EWM, ASD and ECHS
ACAS/EWM experience is highly preferred.
Claims processing experience is a plus.
Solid track record of excellent quality results with a strong claim background.
Good analytical and technical skills.
Strong knowledge of benefit plans, policies and procedures
Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Strong attention to detail.

Responsibilities

Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician.
Prioritize work and be able to multitask to balance projected workload and due dates.
Review provider rework claims in accordance with claim processing and PCR guidelines.
Research claims in the ASD or ACAS/EWM systems.
Research and document claim history in Aetna Strategic Desktop (ASD) and Electronic Correspondence Handling System (ECHS).