The McGregor Foundation · 3 months ago
Junior Claims Analyst
East Cleveland, OH, US
Full-time
Hybrid
New Grad, Entry Level
$22/hr - $24/hrThe McGregor Foundation is a community-based service program providing in-home healthcare services to the elderly. They are seeking a highly motivated and dedicated Junior Claims Analyst to support the administration and operation of the McGregor PACE health plan, contributing to the efficiency of claims processing.
Assisted LivingElderlyHealth CareNon Profit
Responsibilities
Prepare all claims appeals for review by the Director of Health Plan Operations
Code the IBNR (Incurred but Not Reported) report by identifying the appropriate accounts within the Monthly Paid Claims report
Monitor enrollments and disenrollments using the Daily Transaction Reply Report (DTRR) and communicate results for follow-up
Update the rosters folder on SharePoint with participant subsidy letters
Review the claims listed on the Pend reports to see if they meet contracted terms and release for payment when verified
Verify that the End-Stage Renal Disease (ESRD) payments reported on the Monthly Membership Report (MMR) align with the total number of participants receiving these services. Communicate discrepancies as needed
Research external providers' inquiries regarding accuracy and status of payments
Prepare the weekly authorization manifest and submit it to our third-party claims administrator
Process, review, and summarize scheduled claim detail reports as well as ad-hoc requests
Complete other duties assigned by the Senior Claims Analyst or Director of Health Plan Operations
Qualification
Required
High School diploma (required)
Strong verbal and written communication skills (required)
Excellent customer service and organizational skills (required)
Proficiency in Windows, Word, Excel, and PowerPoint (required)
Reliable transportation (required)
Preferred
Associate's degree (preferred)
Healthcare and/or industry experience (preferred)
Strong analytical and problem-solving skills (preferred)
A keen eye for detail when reviewing documentation and ensuring accuracy in claims processing systems (preferred)
Company
The McGregor Foundation
Gracious Senior Living ~ Some places are about the experiences! When it comes to finding the right lifestyle choice, discover McGregor’s gracious hospitality and amenities– an experience that works for you! McGregor is perfectly situated on a picturesque 45-acre estate, overlooking downtown Cleveland and a view of Lake Erie in the distance.
Founded in 1877
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase