Claims Analyst at Arcadia (Remote)

+1 more | Remote
Sorry, this job was removed at 11:27 a.m. (CST) on Thursday, September 15, 2022
Find out who’s hiring remotely Nationwide
See all Remote jobs Nationwide
Apply Now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.
Due to Covid-19 we are working 100% remotely, this includes the hiring process. When it is safe to do so, we will return to a hybrid of onsite and remote work for some positions.
Why This Role Is Important To Arcadia
The Claims Analyst role is responsible for claims processing, reviewing, auditing and investigation of high-level coding review and processing discrepancies. Average number of claims entered weekly 800-1100, depending on level of difficult claims being worked that week.
What Success Looks Like
In 3 months- Familiar with basic navigation in the Eldorado processing system- HCFA and UB92 Workflow Queues in Eldorado System- HCFA and UB92 Pended Claims and Exception Reports- Auditing weekly reports
In 6 months- Review and Finalize 095 report of claims sent to BCBS needing MG review and status of approval.- Working special projects- Familiar with BlueCross portals- Familiar with internal portals, MCG, Arcadia share point, Appeal Module- Processing the minimum requirement of 20 claims per hour.
In 12 months- Assist with other coworker's workflow when assigned client based primary responsibilities are caught up.- Meeting and maintaining production expectations 23-27 claims per hour on commercial accounts- Meeting and maintaining production expectations 18-22 claims per hour on Medicare Advantage.- Meeting quality expectations of an average of 95% or higher- Full understanding of Eldorado system
What You'll Be Doing
    • HCFA and UB92 Pended Claims and Exception Reports
    • HCFA and UB92 Workflow Queues in Eldorado System
    • Audit Reports such as possible duplicates, timely filing review
    • Work special reports such as Anesthesia, Mental Health, etc.
    • Review and Finalize claims appeals received by providers/members
    • Review Pre-payment audit reports
    • Review and Finalize 095 report of claims sent to BCBS needing MG review and status of approval.
    • Assist with other coworker's workflow when assigned client based primary responsibilities are caught up.

What You'll Need to Have
    • High School diploma or equivalent
    • 1 -3 years medical claims adjudication experience (HMO claims preferred)
    • Proficiency in Microsoft Office Applications, high Excel proficiency
    • Excellent verbal and written communication skills
    • Good attention to detail and commitment to quality
    • Positive mental attitude
    • Ability to multi-task
    • Deadline oriented
    • Ability to work independently with minimal supervision

Would Love for You to Have
    • Coding certification
    • Excel
    • Access

What You'll Get
    • Join a high performing team who brings all data into one of the top Healthcare Analytics companies in the US
    • Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
    • A flexible, remote friendly company with personality and heart
    • Employee driven programs and initiatives for personal and professional development
    • Be a member of the Arcadian and Barkadian Community

About Arcadia
Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website , our online resources , and our interactive Data Gallery .
This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.
Read Full Job Description
Apply Now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.
Candidate Location Eligibility:
Boston, MA

Technology we use

  • Engineering
  • Product
  • Sales & Marketing
    • ElixirLanguages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • RubyLanguages
    • ScalaLanguages
    • SqlLanguages
    • TypeScriptLanguages
    • jQueryLibraries
    • jQuery UILibraries
    • ReactLibraries
    • ReduxLibraries
    • Angular.JSFrameworks
    • DockerFrameworks
    • GraphQLFrameworks
    • HadoopFrameworks
    • KafkaFrameworks
    • KubernetesFrameworks
    • Node.jsFrameworks
    • Ruby on RailsFrameworks
    • SparkFrameworks
    • TensorFlowFrameworks
    • CassandraDatabases
    • HiveDatabases
    • MongoDBDatabases
    • NoSQLDatabases
    • PostgreSQLDatabases
    • SnowflakeDatabases
    • HadoopDatabases
    • SQLDatabases
    • AWS (Amazon Web Services)Services
    • GitHubServices
    • Google AnalyticsAnalytics
    • IllustratorDesign
    • PhotoshopDesign
    • PixelmatorDesign
    • AsanaManagement
    • ConfluenceManagement
    • JIRAManagement
    • WordpressCMS
    • HubSpotCRM
    • SalesforceCRM
    • HubspotEmail
    • HubspotLead Gen

An Insider's view of Arcadia

How has your career grown since starting at the company?

When I first came to Arcadia, I was the only person in my department, filling a brand-new role. In my 8 years here, my career has grown rapidly. I am now a Sr Manager of a department of 9, building the auditing program from the ground up and am known as a go-to person within the Value Based Care Services

Beth

Director, Contractual Oversite and Performance

How do you make yourself accessible to the rest of the team?

It's as easy as making time. I meet with my team members for one on ones to understand where their stressors are. Sometimes it's personal and I support with flexibility, time, or PeopleOps other times it's professional and these I tactically work with the team to coach or intervene.

Geo

Director, Engineering

What are Arcadia Perks + Benefits

Arcadia Benefits Overview

We offer industry leading benefits including unlimited vacation that Arcadians are able to use to ensure their work life balance.

Culture
Volunteer in local community
Partners with Nonprofits
Friends outside of work
Eat lunch together
Intracompany committees
Daily sync
Open door policy
Team owned deliverables
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Highly diverse management team
Unconscious bias training
Diversity manifesto
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Pet Insurance
Wellness Programs
Team workouts
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
401(K) Matching
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
Flexible Work Schedule
Remote Work Program
Family Medical Leave
Company sponsored family events
Vacation & Time Off Benefits
Unlimited Vacation Policy
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Beer on Tap
Casual Dress
Company Outings
Game Room
Stocked Kitchen
Some Meals Provided
Happy Hours
Parking
Pet Friendly
Fitness Subsidies
Home Office Stipend for Remote Employees
Professional Development Benefits
Job Training & Conferences
Tuition Reimbursement
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Time allotted for learning
Online course subscriptions available
Customized development tracks
Paid industry certifications

Additional Perks + Benefits

At Arcadia we create programs and opportunities that allow connection with one another and bridge the work from home gap. We host themed events, contests with prizes, and provide resources for shared personal and professional interests.

More Jobs at Arcadia

Apply Now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.
Save jobView Arcadia's full profileSee more Arcadia jobs