Claims Analyst (Hybrid)
Company: CARDINAL SERVICES LTD.
Location: New York
Posted on: January 27, 2023
120 Broadway, New York, NY 10271
VillageCare is seeking an enthusiastic professional for our Full
Time Claims Analyst, which will provide analytic support. The
Claims Analyst will work with the claims data, demographic data,
financial data, and authorization data to generate analyses,
reports, and dashboards that provide insights and help the
department make informed decisions as we work to improve the
accuracy of the claims adjudication.
The role combines technical skills (MS Excel, SQL, database and
Tableau) and strong communication skills, specifically with
non-technical customers, and is able to effectively manage multiple
analysis at the same time. You will monitor and oversee the correct
handling of claims appeals; reviews, examines and directs
processing of claims appeals for all LOB. Work to ensure all
information to providers, IRE/IAHO, and other
parties-to-a-complaint/appeal, and other appropriate persons is
accurate, consistent, and customer sensitive. Conduct monthly
audits of TPA master appeals report and Service Care Logs to ensure
all data is recorded correctly. Provide Quarterly and Bi-Monthly
data for Part C Medicare Appeals (ODAG claims, Timeliness
percentages, Number of discrepancies, Number of late appeals,
Number of IRE appeals and the Number of Overturned appeals) to the
Compliance department. Review and investigate appeals and
grievances requests to ensure all requests are identified,
classified, and fully resolved in a compliant manner.
We would like to speak with those who bring 5+ years of experience
in Health Plan Appeals & Grievances and claims. Experience in an
auditing capacity conducting root cause analysis with knowledge of
state and federal appeal, and grievance regulatory requirements.
DOH NYS and CMS experience required. Vendor oversight and auditing
experience required. Experience with Medicare Guidelines/Timeframes
and knowledge of medical terminology, ICD-10, CPT/HCPCS coding.
There are many benefits to working for VillageCare. If you are
someone who likes being part of a team, enjoys highly competitive
compensation and benefits package, a 403(b) retirement plan and
much more than we would love to speak with you! VillageCare offers
a wide range of at-home and community-based services, as well as
managed long-term care options that seek to match each individual's
needs to help them attain and maintain the greatest level of
independent living possible. We are committed to superior outcomes
in quality health care. VillageCare is a Drug-free workplace. Equal
Keywords: CARDINAL SERVICES LTD., New York , Claims Analyst (Hybrid), Professions , New York, New York
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