You’ll need
Education
✓Bachelor's Degree required
✓High school diploma or GED required AND an additional 4-6 years of claims experience in lieu of degree required
✓Minimum of five years of claims experience without Bachelor's degree required
Qualifications
✓1-3 years claims experience required
✓Thorough knowledge of QNXT and benefit structure to ensure claims accuracy.
✓Ability to define problems, collect data, establish facts and draw valid conclusions.
✓Knowledge of all claim forms and coding types, including UB-04, CMS1500, ICD-9-CM, CPT-4, ICD-10-CM, HCPC, Revenue and NOC coding. HIPPA, HEDIS.
✓Extensive knowledge of claims administration in a healthcare field.
✓Ability to lead/manage projects and interact with staff on all levels.
✓Able to implement testing material for changes with benefit structures for all lines of business.
✓Interact and collaborate with other corporate groups such as Provider Relations, Member Services, Information Systems, Compliance, Third Party Recovery, Finance, Patient Accounts, Enrollment, Utilization Management and Product Line Managers.
✓Key candidate will be adaptable; detailed oriented and have strong analytical skills.
✓Excellent verbal and written communication skills.
✓Access database, Reports, Queue's and other tools as needed.
✓Proficiency in Word, Excel, Webstrat, PowerPoint, Business Intelligence Portals and Audit Tool.
✓Must Live in Colorado
✓This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.
Experience with Medicare, Medicaid and Commercial programs preferred.
Total Claims Capture and Control (TC3) experience preferred.
Working knowledge of CMS/Medicare payment platforms a plus including the Resource Based Relative Value System (RBRVS) and Diagnostic Related Groups (DRG). preferred
Benefits
Medical, dental and visionPaid time offTuition assistancePaid parental leave
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About the role
Under general supervision, Claims Audit Analyst is responsible for benefit administration and assist with the daily management of claims inventory. Daily data analysis and research of claims processing to ensure benefit structures and operation processes are adhering to the rules, regulations and contractual requirements by CMS, DOI, contracted and non- contracted providers.