Be an early applicantLess than 25 applicants
tango · 3 days ago
Analyst, Claims
Phoenix, AZ
Full-time
Onsite
Mid Level
2+ years exp
Wonder how qualified you are to the job?
Maximize your interview chancesAnalyticsHealth Care
Insider Connection @tango
Responsibilities
Processes all “unclean” claims adhering to claims policies and procedures
Confirm reimbursement accuracy upon approving per the Provider Contracts or SCA/LOA agreements on file when processing claims
Analyze claims EOB pend/denial codes and troubleshoot why claim was unclean and collaborate with Claims Customer Service Analysts to educate the provider on claims submission errors
Perform claims reprocessing as assigned
Assist with special reports of processing claim reports and fixing eligibility and authorization mismatches accurately and timely
Apply knowledge of coding in order to determine if claim should be denied or approved per claims policies
Review documentation, analyze submitted claims data with an average of 95% accuracy monthly
Escalate any system issues or roadblocks that prevent hitting claim metrics as applicable
Processing claims within the Claims Policies at 95% accuracy and meeting productivity standards as outlined
Thorough Knowledge of EOB denial/pend codes, HIPPS, HCPCS and DX codes in order to process claims within regulations.
Escalating all Provider Claim issues and systemic errors to ensure positive rapport with our network Providers in accordance with PHCN Claims Policies and Procedures
Perform other duties as assigned within the scope of responsibilities and requirements of the job
Performs the essential functions of this job with or without reasonable accommodation.
Knowledge of Medicaid EVV verification process required for accurate claims processing.
Knowledge of PDGM reimbursement processing for Medicare claims.
Knowledge of authorization process for accurate claims processing.
Good communication skills and team player.
Familiarity with EDI claims/ claims submission related to CMS requirements.
Other duties as assigned.
Qualification
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
2 ~ 4 years of direct experience minimum in Claims Adjudication and Clearinghouse submissions/rejections
Basic Knowledge/understanding of Medicare/Medicaid claims processing and CMS regulations
Detailed knowledge of medical coding; HIPPS, CPT and HCPCS codes
Solid understanding of eligibility as well as claims paying for all lines of business
4~6 years’ work experience that provides a working knowledge of billing and delinquency procedures
Preferred
Beginner level Microsoft Office skills (PowerPoint, Word, Outlook)
Beginner level Microsoft Excel skills
Analytical, research, problem solving, and decision-making skills
Company
tango
tango is a post-acute management services company that provides home healthcare services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Brian Lobley
Chief Executive Officer
Dan Hurley
Chief Technology Officer
Company data provided by crunchbase
