PacificSource Health Plans

Claims Analyst I - Medicaid

US-OR-Bend
Job ID
2017-324
Type
Regular Full-Time
Hiring Pay Range
$14.50 - $16.00
# of Openings
3
Status
Non-Exempt

Overview

Responsible for processing Medicaid claims in a workflow environment. Accurately interpret benefit and policy provisions applicable to Medicaid enrollees. Review and resolve claim edits using multiple systems, processes and procedures. Maintain production and quality standards.

Responsibilities

  1. Perform claims data entry tasks and accurately transfer data from claim images into Facets.  
  2. Work in assigned workflow role to process Medicaid claims.
  3. Accurately interpret benefit and payment provisions applicable to Medicaid enrollees.
  4. Review and resolve claim and system edits using multiple systems, processes and procedures.
  5. Responsible for entering system Notes to record pertinent information involving a claim or member.
  6. Responsible for monitoring and working claims set-aside to ensure claims are released in a timely manner.
  7. Pursue answers to questions needed to process claim.
  8. Route to appropriate workflow queues to resolve setup issues.
  9. Process incoming Faxes and Mail tasks according to department procedure(s) as assigned.
  10. Document and report issues that affect claims processing or accuracy to claims leadership. 

Supporting Responsibilities:

  1. Meet department and company performance and attendance expectations.
  2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
  3. Regularly attend team meetings and daily team visual board huddle.
  4. Perform other duties as assigned.

Qualifications

Work Experience:  One year medical or health insurance experience or equivalent health related education required. Experience working with QNXT, Facets, or other similar systems strongly preferred.

 

Education, Certificates, Licenses: High school diploma or equivalent required.

 

Knowledge: Ability to develop a thorough understanding of PacificSource Medicaid products, plan designs, provider/network relationships and health insurance terminology. Research skills and ability to evaluate claims in order to enter and process accurately. Preferred computer skills include keyboarding and 10-key proficiency, basic Microsoft Word and Excel. Ability to prioritize work and perform under time constraints. Team player willing to collaborate and help others accomplish team objectives.

 

Competencies

Our Values

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for our customers’ experience.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our communities-internal and external.
  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

 

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

    

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

 

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

 

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. 

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