What are the responsibilities and job description for the Claims Analyst position at NTT DATA?
CLAIMS ANALYST – HEALTHRULES (TEMPORARY – MARCH 7 TH START DATE)
Position Description
This position is responsible to research, resolve, examine and process paper and or electronic claims submitted for payment. Interact with internal customers to obtain needed information for claim processing. Process claims and adjustments in accordance with policies and procedures, coordination of benefits utilizing appropriate plan provisions, CMS Regulations and Client guidelines for payment determination.
· Responsible for independent review and timely/accurate processing of claims in accordance with Client and CMS Regulations and Claims Department Work Instructions.
· Process claims cross-functionally for products while maintaining production and quality standards.
· Respond timely to claims inquiries and issues. Inquiries may include phone calls, e-mails, and verbal requests including services agreements and recovery requests.
· Work pending files and provide timely communication as directed by CCO Leadership. Follow up on pending claims and adjustments accordingly to Department Service Level Agreements and regulatory requirements.
· Interact with internal customers to obtain needed information to process claims and to provide detailed claim information for resolution.
· Other projects and duties as assigned.
Education
High School diploma or equivalent.
Required Experience
Two years of experience processing medical claims. Knowledge of CPT, HCPCS and ICD-10 coding and industry terminology and Medicare and Medicaid regulations. Proficient in claims processing.
Preferred Experience
Experience in a healthcare organization, working knowledge of Medicaid, Medical Assistance, Minnesota Care, Medicare and Commercial. Amisys Claims System, HealthRules Payor and MACESS EXP experience.
Contract length: 12 months
Job Types: Full-time, Contract
Salary: $18.00 - $22.00 per hour
Schedule:
- 8 hour shift
Work Remotely:
- Yes
