Claims Analyst (Hybrid)

Company: CARDINAL SERVICES LTD.
Location: New York
Posted on: January 27, 2023

Job Description:

Claims Analyst
VillageCare
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 Opportunity Employer.

Keywords: CARDINAL SERVICES LTD., New York , Claims Analyst (Hybrid), Professions , New York, New York