Claims Analyst

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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 Processor 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.

 

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Candidate Location Eligibility:
Albuquerque, NM
Ann Arbor, MI
Atlanta, GA
Austin, TX
Baltimore, MD
Baton Rouge, LA
Birmingham, AL
Boise, ID
Boston, MA
Buffalo, NY
Charleston, SC
Charlotte, NC
Chicago, IL
Cincinnati, OH
Cleveland, OH
Colorado, CO
Columbus, OH
Dallas-Fort Worth, TX
Dayton, OH
Des Moines, IA
Detroit, MI
Fayetteville-Springdale-Rogers, AR
Greensboro, NC
Hampton Roads, VA
Hartford, CT
Houston, TX
Huntsville, AL
Indianapolis, IN
Jacksonville, FL
Kansas City, MO
Las Vegas, NV
Lexington, KY
Lincoln, NE
Little Rock, AR
Los Angeles, CA
Louisville, KY
Madison, WI
Memphis, TN
Miami, FL
Milwaukee, WI
Minneapolis–Saint Paul, MN
Nashville, TN
New Orleans, LA
New York City, NY
Ogden, UT
Oklahoma City, OK
Omaha, NE
Orlando, FL
Other US Location
Palm Bay-Melbourne-Titusville
Pensacola, FL
Peoria, IL
Philadelphia, PA
Phoenix – Mesa – Scottsdale, AZ
Pittsburgh, PA
Portland, ME
Portland, OR
Providence, RI
Provo, UT
Raleigh-Durham, NC
Reno, NV
Richmond, VA
Rochester, NY
Sacramento, CA
Salt Lake City, UT
San Antonio, TX
San Diego, CA
San Francisco, CA
San Luis Obispo, CA
Santa Cruz, CA
Seattle, WA
Spokane, WA
St. Louis, MO
Tallahassee, FL
Tampa Bay, FL
Tucson, AZ
Tulsa, OK
Washington DC
Wichita, KS
Wilmington, NC

Technology we use

  • Engineering
  • Product
  • Sales & Marketing
  • People Operations
    • C#Languages
    • C++Languages
    • ElixirLanguages
    • GolangLanguages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • RubyLanguages
    • ScalaLanguages
    • SqlLanguages
    • TypeScriptLanguages
    • ChatGPTLanguages
    • jQueryLibraries
    • jQuery UILibraries
    • ReactLibraries
    • ReduxLibraries
    • AngularFrameworks
    • Angular.JSFrameworks
    • ASP.NETFrameworks
    • DockerFrameworks
    • GraphQLFrameworks
    • HadoopFrameworks
    • KafkaFrameworks
    • KubernetesFrameworks
    • Node.jsFrameworks
    • OAuthFrameworks
    • React NativeFrameworks
    • Ruby on RailsFrameworks
    • SparkFrameworks
    • SpringFrameworks
    • TensorFlowFrameworks
    • TerraformFrameworks
    • Vue.jsFrameworks
    • AccessDatabases
    • AWS RedshiftDatabases
    • CassandraDatabases
    • DynamoDBDatabases
    • ElasticsearchDatabases
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    • Microsoft SQL ServerDatabases
    • MongoDBDatabases
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    • Microsoft TeamsCollaboration
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An Insider's view of Arcadia

What's something quirky about your company?

Arcadia's Got Talent (AGT) is an annual talent show that I won last year. The best part about AGT was that it encouraged me to work on something I am passionate about outside of work. All of the entries were amazing & I think it's really awesome that the company does things to bring people together and celebrate our passions outside of the office.

Gary

Engineering Manager

What does your typical day look like?

Every day is a little bit different, which I really love and helps keep me engaged! Most days I have a combination of phone screens and meetings with my hiring managers or team. I also help manage a lot of our brand partnerships that have projects through out the year and play a part in helping construct Arcadia's company culture as we scale.

Julie

Talent Acquisition Manager

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

How does the company support your career growth?

Arcadia is incredibly generous when it comes to career growth. I receive regular mentorship from my manager and leadership team. I also have a continuing education stipend that I use to take courses and attend conferences to further my skillset. My career path is mapped out and regularly adjusted with my professional interests and personal growth.

Mike

Senior Manager, Content

What are Arcadia Perks + Benefits

Arcadia Benefits Overview

We leverage cutting-edge technologies to enhance our work environment. From advanced collaboration tools to virtual reality experiences, we embrace technology to streamline processes and enhance the overall employee experience.

We offer industry leading benefits including unlimited vacation that Arcadians are able to use to ensure their work life balance. Work alongside and learn from highly skilled and experienced coworkers and teams.

Annual wellness program encourages fitness as a habit. Ongoing learning opportunities to enhance skills and advance careers.

Our commitment is to create a workplace where employees feel supported, valued, and empowered in all aspects of their professional and personal lives.

Your innovative spirit is not just appreciated; it's celebrated.

Culture
Volunteer in local community
We have a compassion club that raises money throughout the year and organizes annual Toys for Tots Drives and Breast Cancer Awareness fundraising programs.
Partners with nonprofits
Open door policy
OKR operational model
Open office floor plan
Employee resource groups
Employee-led culture committees
Flexible work schedule
Remote work program
Diversity
Highly diverse management team
Mandated unconscious bias training
Diversity employee resource groups
Hiring practices that promote diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability insurance
Dental insurance
Vision insurance
Health insurance
Life insurance
Pet insurance
Wellness programs
Team workouts
Mental health benefits
Transgender health care benefits
Financial & Retirement
401(K)
401(K) matching
Performance bonus
Child Care & Parental Leave Benefits
Childcare benefits
Dependent care flexible spending account plan
Generous parental leave
Family medical leave
Fertility benefits
Vacation & Time Off Benefits
Unlimited vacation policy
Generous PTO
Paid holidays
Paid sick days
Flexible time off
Bereavement leave benefits
Office Perks
Commuter benefits
Mass transit and parking FSA plans
Company-sponsored outings
Free snacks and drinks
Some meals provided
Company-sponsored happy hours
Fitness stipend
This is a medical plan perk
Home-office stipend for remote employees
Professional Development Benefits
Job training & conferences
Lunch and learns
Promote from within
Continuing education available during work hours
Online course subscriptions available
Customized development tracks
Paid industry certifications
Personal development training

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. We have "No Meeting Fridays" to allow employees time for deep focus work and planning.

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