Senior Claims Analyst

Claritev•New York, NY

2d•$75 - $85

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 as analyzing medical claims paid/processed data. Bachelors' degree in a relevant field of study is strongly preferred.
Experience on Multiple Claims Processing Platforms.
Experience on Multiple Clients with varying Claims Processing Policies.
Experience with Various Types of Medical Health Care Claims, including but not limited to: Inpatient Outpatient Professional
Experience with Various Types of Medical Health Care Payment Methods, including but not limited to: DRG Per Diem Outpatient Surgery Groupers RUG OASIS Fee Schedule
Required licensures, professional certifications, and/or Board certifications as applicable.
Recognize New Concepts that Lead to Overpayments.
Works Efficiently on Multiple Clients.
Utilizes tools to Identify New Concepts on Data (ReThink Analyzer).
Attention to Detail.
Proven Problem-Solving Abilities.
Excellent Written Communication Skills.
Effective Time Management Skills.
Flexible During Time of Change.
Highly Self-Motivated.
In Addition to Claims Analyst: Ability to Apply New Technologies/Techniques Quickly and Efficiently. Efficiently Adapt to Shifting Priorities/Timelines.
Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

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: o Client Claims Processing Policies/Systems. o CMS/OIG/RAC Public Information. o Provider/Member Contracts. o State Medicaid Plans Public Information. o Review of Adjustment Claims.
Document new concepts in an appropriate format outlined by management.
Partners with Microsoft SQL developers to develop efficient output of concept following concept development Process as Defined by Management.
Communicate to management any issues that impact work performance and work with management to resolve any Issues that impact work performance.
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's Core Competencies and values held within.
Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
The position responsibilities outlined above are in no way to be construed as all encompassing. 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 the laws of the state in which the employee is located provide for more generous sick time benefits