Due to Covid–19 we are working 100% remotely, this includes the hiring process. When it is safe to do so, we will return to a hybrid of onsite and remote work for some positions.
Why This Role Is Important To Arcadia
The Claims Analyst role is responsible for claims processing, reviewing, auditing and investigation of high-level coding review and processing discrepancies. Average number of claims entered weekly 800-1100, depending on level of difficult claims being worked that week.
What Success Looks Like
In 3 months
- Familiar with basic navigation in the Eldorado processing system
- HCFA and UB92 Workflow Queues in Eldorado System
- HCFA and UB92 Pended Claims and Exception Reports
- Auditing weekly reports
In 6 months
- Review and Finalize 095 report of claims sent to BCBS needing MG review and status of approval.
- Working special projects
- Familiar with BlueCross portals
- Familiar with internal portals, MCG, Arcadia share point, Appeal Module
- Processing the minimum requirement of 20 claims per hour.
In 12 months
- Assist with other coworker’s workflow when assigned client based primary responsibilities are caught up.
- Meeting and maintaining production expectations 23-27 claims per hour on commercial accounts
- Meeting and maintaining production expectations 18-22 claims per hour on Medicare Advantage.
- Meeting quality expectations of an average of 95% or higher
- Full understanding of Eldorado system
What You’ll Be Doing
HCFA and UB92 Pended Claims and Exception Reports
HCFA and UB92 Workflow Queues in Eldorado System
Audit Reports such as possible duplicates, timely filing review
Work special reports such as Anesthesia, Mental Health, etc.
Review and Finalize claims appeals received by providers/members
Review Pre-payment audit reports
Review and Finalize 095 report of claims sent to BCBS needing MG review and status of approval.
Assist with other coworker’s workflow when assigned client based primary responsibilities are caught up.
What You’ll Need to Have
High School diploma or equivalent
1 -3 years medical claims adjudication experience (HMO claims preferred)
Proficiency in Microsoft Office Applications, high Excel proficiency
Excellent verbal and written communication skills
Good attention to detail and commitment to quality
Positive mental attitude
Ability to multi-task
Deadline oriented
Ability to work independently with minimal supervision
Would Love for You to Have
Coding certification
Excel
Access
What You’ll Get
Join a high performing team who brings all data into one of the top Healthcare Analytics companies in the US
Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
A flexible, remote friendly company with personality and heart
Employee driven programs and initiatives for personal and professional development
Be a member of the Arcadian and Barkadian Community