Claims Analyst

Role: Claims Examiner
Location: Phoenix, AZ (Hybrid)

Type: Full time

Summary: Under the direction of the Accounting Manager, the Claims Payment Specialist is primarily responsible for ensuring that claims are selected for payment according to client regulations and client processing rules. The position is responsible for ensuring all payments are authorized by the client, and check dates are updated in the claims system.

Training: 2-3 weeks in office

Post training schedule: Hybrid 3 days in office located in Phoenix, AZ and 2 days work from home

Essential functions:

- Generate pre-check register and authorization form for clients

- Verify approvals have been received

- Modify pre-check based on approvals received, ensuring the batch ties to the client

approval

- Generate export file from claims system for check printing

- Obtain secondary approval from clients in situations with interest payments, prior to

releasing export file for check printing

- Import check register file into claims system

- Coordinate voided checks with the claims department

Additional Functions:

- Assists with special projects, as requested

- Communicates clearly and concisely, with sensitivity to the needs of others

- Maintains the confidentiality of all company procedures, results, and information about

participants, clients, providers and employees

- Maintains courteous, helpful and professional behavior on the job

- Establishes and maintains effective working relationships with co-workers

- Ensures customer satisfaction by understanding and applying the Customer Service

Policy, Procedure and Standards

- Follows all Policies and Procedures and HIPAA regulations

- Maintains knowledge and understanding of current Medicare regulations related to PACE

Health Plan Management.

- Maintains a safe working environment

- Maintains knowledge and understanding of current Medicare claims processing

guidelines

- Attends continuing education seminars as requested

Knowledge, Skills and Abilities:

- Associates Degree in Accounting or equivalent experience required

- 2 years of related work experience in and office setting

- Proficient in Microsoft Word and Excel

- Experience with Pivot Tables is required

- Detail oriented with strong analytical skills

- Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels

- Skilled in data analysis and problem solving using defined methodologies

- Ability to work independently with minimal supervision

- Ability to independently follow through on projects

- Ability to communicate professionally, clearly and effectively, verbally and in writing

- Ability to prioritize effectively

-Ability to consistently multitask

- Ability to understand issues, demonstrates resourcefulness, and resolve issues in a timely manner

- Ability to demonstrate good judgment and have excellent critical thinking skills