Reimbursement Analyst II

Important things YOU should know:  

• Schedule: The hours of operation are Monday – Friday from 7:00am – 5:00pm CST   
• Potential to flex schedule within hours of operation
• Fully remote role

What will YOU be doing for us?   Ensure accurate and timely payment of claims to dental/vision providers.  Utilize research and knowledge of coverage and benefits to ensure resolution to more difficult claim payment issues.

What will YOU be working on?   

• Submit accurate and timely payments to providers, keeping within contractual service level agreements for each market.  Develop and maintain controls over the proprietary processed data and systems set up through developing and implementing auditing procedures, and identifying potential claim audit exposures. 
• Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
• Assure that claims are paid within the expected time frames by monitoring inventory control and working with team members and appropriate resources in other areas to resolve issues related to claims entry.
• Identify trends and suggest and develop efficiencies in the review of edit reports and other documentation by reviewing procedures and making appropriate suggestions and adjustments to procedures.
• Resolve complex claim payment inquiries by analyzing patient activity and related documentation (including enrollment, claims, and authorizations) and determine appropriate action to be taken.
• Resolve complex client issues that may require research, analysis and working with management.
• Complete requests for claims review and/or reprocess within internal guideline turnaround times.

Additional Responsibilities:

• Develop and maintain client and provider relationships by interacting directly with the client and providing necessary feedback and communications as needed.
• Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules for check run procedures as needed.

What qualifications do YOU need to have to be GOOD candidate? 

• Required Level of Education, Licenses, and/or Certificates
  • High school diploma or equivalent

• Required Level of Experience
  • 2 years of prior job related experience (Dental Assistant, Dental/Medical front office, or health/dental insurance, including managed care operations, accounts receivable and or billing)

• Required Knowledge, Skills, and Abilities
  • Knowledge of health or dental procedures coding and terminology
  • Basic knowledge of Microsoft software (Outlook, Excel and Word)  
  • Exceptional written and verbal communication skills

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, License, and/or Certificates
  • Bachelor’s Degree in a related field

• Preferred Level of Experience
  • Knowledge of claim processing within the healthcare field
  • Demonstrated experience with MS Office Suite