Lead Claims Analyst
Company: Highmark Health
Location: Saint Paul
Posted on: August 6, 2022
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Job Description:
**Company :**Helion**Job Description :****JOB SUMMARY**This job
is a key member of the Helion Network Operations team that screens,
reviews, evaluates, corrects errors, and/or reviews for quality
control and provides final adjudication instruction of
paper/electronic claims. Determines whether to return, deny or pay
claims following organizational policies and procedures. Provides
direction on corrective actions needed including but not limited to
processed claims, using enrollment, benefit and historical claim
processing information. This job will perform post-payment reviews
and advise on corrective adjustments as deemed appropriate. This
role will work across the matrix to partner with key functions,
including Health Plan Operations (HPO), provider contracting,
provider audit, and other key implementation stakeholders, and may
support multiple health plan clients.This job is a key member of
the Helion Network Operations team that screens, reviews,
evaluates, corrects errors, and/or reviews for quality control and
provides final adjudication instruction of paper/electronic claims.
Determines whether to return, deny or pay claims following
organizational policies and procedures. Provides direction on
corrective actions needed including but not limited to processed
claims, using enrollment, benefit and historical claim processing
information. This job will perform post-payment reviews and advise
on corrective adjustments as deemed appropriate. This role will
work across the matrix to partner with key functions, including
Health Plan Operations (HPO), provider contracting, provider audit,
and other key implementation stakeholders, and may support multiple
health plan clients. .**ESSENTIAL RESPONSIBILITIES**+ Determine if
claim information submitted is accurate and complete in line with
requirements for bundled payment processing.+ Provide processing
instruction to claims adjudicator(s)+ Provide resolution on claim
rejections, review history records and determine benefit
eligibility for service.+ Review payment levels to arrive at final
payment determination.Work with provider network to solve claim
inquiries.+ Attend all required training classes.+ Elevate issues
to next level of supervision, as appropriate.+ Maintain accurate
records, including timekeeping records.Other duties as assigned or
requested.**EDUCATION****Minimum**+ High School
Diploma/GED**Preferred**+ None**EXPERIENCE**Experience in Health
Care Revenue Cycle Industry (i.e. Billing, Claims, etc.) - Provider
or PayorTo Include: Business Analysis**Required**+ 5-10 years of
related, progressive experience**Preferred**+ Typing speed of at
least 60 words per minute**LICENSES OR
CERTIFICATIONS****Required****Preferred**Experience in Health Care
Revenue Cycle Industry (i.e. Billing, Claims, etc.) - Provider or
PayorTo Include: Business Analysis**SKILLS**Provider
ReimbursementMicrosoft Word, ExcelOral & Written Communication
SkillsTeamwork and CollaborationAbility to take direction and to
navigate through multiple systems simultaneously.Knowledge of
administrative and clerical procedures and systems such as word
processing and managing files and records.Ability to use
mathematics to adjudicate claims.Ability to solve problems within
pre-defined methods and guidelines.Knowledge of operating systems
specific to claim processing.**Language**No**Travel
Requirement**Yes**Position Type**RemoteTeaches / trains others
regularlyFrequentlyTravel regularly from the office to various work
sites or from site-to-siteOccasionallyWorks primarily out-of-the
office selling products/services (sales employees)NeverPhysical
work site requiredYesLifting: up to 10 poundsConstantlyLifting: 10
to 25 poundsOcassionallyLifting: 25 to 50
poundsOccasionally**_Disclaimer:_** _The job description has been
designed to indicate the general nature and essential duties and
responsibilities of work performed by employees within this job
title. It may not contain a comprehensive inventory of all duties,
responsibilities, and qualifications required of employees to do
this job._**_Compliance Requirement:_** _This position adheres to
the ethical and legal standards and behavioral expectations as set
forth in the code of business conduct and company policies_As a
component of job responsibilities, employees may have access to
covered information, cardholder data, or other confidential
customer information that must be protected at all times. In
connection with this, all employees must comply with both the
Health Insurance Portability Accountability Act of 1996 (HIPAA) as
described in the Notice of Privacy Practices and Privacy Policies
and Procedures as well as all data security guidelines established
within the Company's Handbook of Privacy Policies and Practices and
Information Security Policy.Furthermore, it is every employee's
responsibility to comply with the company's Code of Business
Conduct. This includes but is not limited to adherence to
applicable federal and state laws, rules, and regulations as well
as company policies and training requirements.Highmark Health and
its affiliates prohibit discrimination against qualified
individuals based on their status as protected veterans or
individuals with disabilities, and prohibit discrimination against
all individuals based on their race, color, religion, sex, national
origin, sexual orientation/gender identity or any other category
protected by applicable federal, state or local law. Highmark
Health and its affiliates take affirmative action to employ and
advance in employment individuals without regard to race, color,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability.Highmark Health and its
affiliates prohibit discrimination against qualified individuals
based on their status as protected veterans or individuals with
disabilities, and prohibit discrimination against all individuals
based on their race, color, age, religion, sex, national origin,
sexual orientation/gender identity or any other category protected
by applicable federal, state or local law. Highmark Health and its
affiliates take affirmative action to employ and advance in
employment individuals without regard to race, color, age,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability.EEO is The LawEqual
Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
_https://www.eeoc.gov/sites/default/files/migrated\_files/employers/poster\_screen\_reader\_optimized.pdf_
)We endeavor to make this site accessible to any and all users. If
you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.For accommodation requests, please
contact HR Services Online at
HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act
Employees, Contractors, and Applicants NoticeReq ID: J190889
Keywords: Highmark Health, St. Paul , Lead Claims Analyst, Professions , Saint Paul, Minnesota
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