Healthcare Claims Customer Service Analyst (Remote)

Healthcare Claims Customer Service Analyst (Remote)

Join to apply for the Healthcare Claims Customer Service Analyst (Remote) role at tango.

Brief Description

• Manage all claims appeals, including disputes, redeterminations, and reconsiderations
• Confirm reimbursement accuracy and work with Networks, Medicaid, and Medicare for questions or concerns
• Analyze claims activity and work reports received by providers, networks, or management
• Perform claims reprocessing, reexporting and address medical billing issues
• Assist with special reports of tracking problems with medical claims according to HIPAA guidelines, contracts, fee schedules and provide education to providers/internal staff as applicable
• Apply knowledge of coding to determine if dispute is valid
• Review documentation, analyze reject claim data, justify CPT & HCPCS codes and pay HCFA?1500 and UB92 claims
• Take inbound customer?service calls and make outbound calls to providers
• Investigate pending claims and resolve discrepancies
• Explain EDI claims transmissions and educate providers on rejection reasons and how to resolve the issue to ensure clean claim submissions
• Contact providers to provide necessary billing guidelines to comply with quality and process standards
• Follow established guidelines specific to each claim report or inquiry
• Review, coordinate and respond to all request or record requests in a timely order
• Responsible for delivery of EOPs to providers after each claim run
• Responsible for investigating clearinghouse rejections, ensuring rejection letters are accurate and of high quality
• Collaborate with networks on escalating all high?volume rejection/denial claims by provider as communicated in bi?weekly claim dashboards and provide an improvement plan on submission of clean claims for timely payments
• Participate in the monthly Claim Webinar Training with our network

Essential Job Functions And Duties

• Oversee review of claims inventory for quality and findings in external audits from all payors/producers as well as annual internal audit in accordance with PHCN Claims Policies and Procedures
• Handle all claim escalations (verbal and electronic) in accordance with PHCN Claims Policies and Procedures
• Escalate high?volume provider claim issues to ensure positive rapport with our network providers in accordance with PHCN Claims Policies and Procedures
• Mentor new team members and provide assistance and review of quality of work during onboarding
• Perform other duties as assigned within the scope of responsibilities and requirements of the job
• Perform essential functions of this job with or without reasonable accommodation

Essential Qualifications

• 5 7 years of direct experience minimum in Claims Adjudication and Clearinghouse submissions/rejections
• Advanced level of skills and knowledge of technical system operations
• Detailed knowledge of medical coding; HIPPS, CPT and HCPCS codes
• Solid understanding of enrollment and eligibility as well as claims paying for all lines of business
• Solid understanding of claim data sets required on Encounter Files to ensure resubmission of claims/disputes are in accordance to 837 CMS regulations
• 1 3 years working in a claims inbound call center
• Professional level training that provides a general understanding of:
  
  • The administration of all contractual obligations
  • Audit and billing procedures
  • Policies and procedures
  • How the processing of accounts receivable and eligibility requirements impacts claims processing
  • Vendor data feeds and discrepancy process
  • Administrative and regulatory requirements
  • Technical workflow processes
  • Functional requirements of the system
  • Solution design documents
  
  
• 4 6 years work experience that provides a working knowledge of:
  • Billing and delinquency procedures
  • Accounts receivable process
  • System testing and enhancement process
  • Web portal data support
  
  
  
  

Skills And Abilities

• Advanced level Microsoft Office skills (PowerPoint, Word, Outlook)
• Advanced level Microsoft Excel skills
• Advanced level of Web Reports and how to read 837 files to support working of encounter rejections
• Interpersonal, communication (written and verbal) and presentation skills
• Analytical, research, problem?solving, and decision?making skills
• Ability to monitor team goals
• Ability to lead and coach team members

Seniority level: Mid?Senior level

Employment type: Full?time

Job function: Other

Industries: Hospitals and Health Care

Referrals increase your chances of interviewing at tango by 2x

Get notified about new Customer Service Analyst jobs in Phoenix, AZ.

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.