The Claims Research Analyst position is critical for ensuring accurate, timely, and proactive communication to provider agencies related to claims submission, denial management, and system updates. The Claims Research Analyst position is critical for the reviewing, monitoring, and auditing claims and for educating the provider community to foster successful submission of claims. Claims Research Analysts research and analyze routine and complex claims data to determine that payments and settlements have been made in accordance with Alliance practices and procedures. Claims Research Analysts track trends and patterns, prepare data for monthly claims reports. This position is also a primary communication point for providers experiencing an array of claims difficulties. This position serves to provide excellent customer service to provider agencies.

The Claims Research Analyst I responsibilities include (but are not limited to):

• Manage phone queue for general calls
• Review, key, process, status, track, and file Special Invoicing claims submissions
• Review patient and provider account updates in MCS and re-adjudicate claims as appropriate; including for retroactive Medicaid coverage, retroactive authorizations, provider contract updates, clinician credentialing updates

Requirements

Bachelor’s degree in related field and minimum of 1 year experience; or Graduation from high school plus two years minimum related experience.

Knowledge and Skills

• Ability to set objectives and prioritize workflow
• Ability to document clearly and accurately
• Ability to solicit cooperation from persons and departments throughout the organization
• Ability to adhere to department policies, procedures, and general practices
• Knowledge of computer software including Excel, Word, Outlook
• Ability to work independently and as part of a team
• Excellent customer service skills
• Ability to demonstrate professional conduct in all situations
• Working knowledge of healthcare services and systems
• Working knowledge of functions provided by Provider Networks, Utilization Management, Accounts Payable, Contracts, Care Coordination in order to effectively identify claims needs and collaborate effectively with appropriate departments
• Knowledge of common claims denials and sources for correction
• Strong organizational skills
• Ability to solve complex problems through the evaluation of alternative methods and solutions

Additional Training Preferred:

Prior experience in a behavioral healthcare agency preferred.

Salary Range

$18.19 to $31.32/Hourly