Senior Claims Analyst

Claritev•New York, NY

2d•$70,000 - $80,000

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! JOB SUMMARY This role recognizes and reports new concepts for development with minimum assistance. The incumbent might be tasked to multiple clients and/or programs. They also understand the data mining process and will occasionally be tasked with training and assistance on process improvements.

Requirements

Minimum high school diploma and two (2) years' experience analyzing medical claims paid/processed data. Bachelor’s degree in a relevant field of study is strongly preferred.
Experience on multiple claims processing platforms.
Experience working across multiple clients with varying claims processing policies.
Experience with various types of medical healthcare claims, including: Inpatient Outpatient Professional
Experience with various types of medical healthcare payment methods, including: DRG Per Diem Outpatient Surgery Groupers RUG OASIS Fee Schedule
Required licensures, professional certifications, and/or board certifications as applicable.
Ability to recognize new concepts that lead to overpayments.
Ability to work efficiently across multiple clients.
Experience utilizing tools to identify new concepts on data (ReThink Analyzer).
Strong attention to detail and proven problem-solving abilities.
Excellent written communication skills.
Effective time management skills.
Flexibility during times of change.
Highly self-motivated.
Ability to quickly apply new technologies/techniques and adapt to shifting priorities and timelines.
Ability to work in a standard office environment, including prolonged sitting, use of monitors, and standard office equipment.
Ability to meet physical and environmental job requirements in compliance with ADA and other employment regulations.

Responsibilities

Researches new concepts for development to determine applicability to client requirements.
Effectively utilize department tools to research concepts as appropriate, including but not limited to: Client Claims Processing Policies/Systems CMS/OIG/RAC Public Information Provider/Member Contracts State Medicaid Plans Public Information Review of Adjustment Claims
Document new concepts in an appropriate format outlined by management.
Partner with Microsoft SQL developers to develop efficient output of concepts following the concept development process as defined by management.
Communicate to management any issues that impact work performance and work with management to resolve them.
Provide appropriate feedback to management on areas of improvement.
Aid in the training and mentorship of new team members as appropriate.
Document how to validate overpayments at a conceptual level.
Aid in the documentation of concept approval forms for clients as necessary.
Collaborate, coordinate, and communicate across disciplines and departments.
Ensure compliance with HIPAA regulations and requirements.
Demonstrate company core competencies and values.
Due to exposure of PHI sensitive data, this role is considered a High Risk Role.
Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Benefits

Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off – accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless otherwise required by state law