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Mecklenburg County · 13 hours ago

Claims Management Analyst

Mecklenburg County, NC

Full-time

Onsite

Entry, Mid Level

$63K/yr - $83K/yr

2+ years exp

Mecklenburg County is seeking a Claims Management Analyst to perform research and analysis for claims management within the finance department. The successful candidate will manage projects, advise management on results, and recommend necessary adjustments to department procedures.

GovernmentOffice AdministrationService Industry

Responsibilities

Analyze claim data to ensure proper reimbursement and advises management of results

Monitor and analyze all referred accounts to determine categorization, level of the appeal process, and personally handle complex appeal responses for private health care, government-specific denials, and recommend necessary adjustments to department procedures

Work under the guidance of department management on strategic projects to include assisting in the establishment of goals and objectives

Respond to requests from State, County, local municipality government, external partners such as payers, external clinicians or community stakeholders

Manage various projects aligned with Strategic Business Plan goals

Gather and organize information about the problem to be solved or the procedure to be improved

Meet with program leaders and conduct on-site observations to develop training materials implement quality assurance processes, and to serve as a resource to internal departments, financial institutions, and external agencies

Analyze financial and other data; including, but not limited to, revenue, expenditure, and insurance payer reports

Develop solutions or alternative practices

Recommend new systems, procedures, or organizational changes

Make recommendations to management through presentations or written reports

Confer with managers to ensure that the changes are successfully implemented and creating positive results

Qualification

Revenue cycle principlesHealthcare codingBillingData managementCertified Professional CoderAccounting principlesData visualizationCustomer serviceMicrosoft Office SuiteProject managementCollaborationActive listening

Required

Minimum of two years' experience in a related field

Bachelor's degree in Business Administration, Public Administration, Data Analytics or a related field

May require a valid North Carolina or South Carolina Driver's License

May require County Driving Privileges

Knowledge of accounting principles

Knowledge of medical terminology, ICD-10, CPT, and HCPCS codes

Knowledge of principles and processes for providing customer and personal services; this includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction

Knowledge of business and management principles involved in strategic planning, project management, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources

Knowledge of structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar

Skills in data management and data visualization

Skills in understanding written sentences and paragraphs in work related documents

Skills in talking to others to convey information effectively

Skills in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems

Skills in identifying complex problems and reviewing related information to develop and evaluate options and implement solutions

Ability to effectively manage one's time and resources to ensure that work is completed efficiently

Ability to develop and use collaborative relationships to facilitate the accomplishment of work goals

Ability to maintain effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements or cultures

Ability to set up ongoing procedures to collect and review information needed to manage an organization or ongoing activities within it

Ability to work effectively and cooperatively with others; establishing and maintaining good working relationships

Ability to give full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate

Advanced proficiency in various computer applications including Microsoft Office Suite