Claims Analyst Jobs Vacancy in Alliance Behavioral Healthcare Durham
Alliance Behavioral Healthcare Durham urgently required following position for Claims Analyst. Please read this job advertisement carefully before apply. There are some qualifications, experience and skills requirement that the employers require. Does your career history fit these requirements? Ensure you understand the role you are applying for and that it is suited to your skills and qualifications.
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Claims Analyst Jobs Vacancy in Alliance Behavioral Healthcare Durham Jobs Details:
The Claims Analyst reviews adjudicated claims prior to payment, for possible third party coverage, trends and patterns to identify areas of concern, and re-verifies system compliance. The Claims Analyst also assist in the development of analytical reports and evaluates budgets based on disabilities and specialties. The position identifies irregularities and works with Claims Auditors to investigate claims. Specific job duties may relate to hospital claims. The ability to work independently, have strong analytical skills and to be proficient in the techniques of research, statistical analysis and report presentation are required.
- Conduct pre and post-payment reviews of claims for accuracy of system edit application, data entry errors, member eligibility for services, provider payment rates, application of manual overrides within the claims division, and reverted or adjusted claims
- Independently and proactively identifies chronic problems that are contributing to QA issues and recommends alternative solutions. Develops tracking and resolution mechanisms to these chronic issues to track effectiveness of resolution and time frames
- Provides direction to the system team to support development of system enhancements in a structured manner aimed to eliminate system settings and or processes that contribute to poor result
- In conjunction with other MCO resources, strives to maintain processes that are consistent with and compliant to CMS, state, federal and URAC standards, regulations and guideline
- Analyzing provider submitted claims by category of service, service codes, rates, etc.
- Review claim reports weekly and summarize data for Claims Supervisor
- Make recommendations for resolving complex, severe exposure claims, using high service oriented file handling
Requires a Bachelor’s degree in a business related field and at least two (2) years of experience in claims analysis; or Associates degree in a business related field and four (4) years of experience in claims analysis or an equivalent combination of education and experience that provide the essential knowledge and abilities to perform the job.
Additional Training Preferred:
- Extensive knowledge of hospital claims and NC Tracks preferred
- Prior experience in a behavior healthcare agency preferred