Claims Analyst

Position Overview:

The Claims Analyst will ensure accurate, timely processing and payment of claims. Claims Analyst resolve any claims issues and serve as a liaison for CBH providers for all claims matters.

Essential Functions :

• Claims Processing: Review claims to ensure accurate processing. Analyst are responsible for handling both TPL and non-TPL institutional and professional claims.
• Provider Support: Serving as a liaison for providers regarding payment issues.
• Data Analysis: Utilizing knowledge of billing codes, BHSRCC, CBH Business Rules and Contracts to review claims/encounters.
• System Knowledge: Ensure compliance with financial and regulatory guidelines.
• Claims Processes: Responsible for completing claims appeals, claims adjustments, and member eligibility discrepancies.
• Provider Training: Train provider on claims processes and procedures.

Responsibilities:

• Analysts are responsible to review claims to troubleshoot provider issues, as well as, address any CBH internal claims questions.
• Answer phone calls and emails from providers within 24 to 48 hours.
• Ability review and analyze claims data using multiple applications.
• Ability to multitask and aggregate claims data.
• Complete claims reversal/reprocessing, appeal, eligibility discrepancies, and Business Rule request. Create tickets via JIRA/Freshworks to track issues.
• Review claims data and provide comprehensive analysis to providers.
• Report out the status of assigned providers. Maintain overall knowledge of assigned providers claims issues and claim history.
• Work with other departments with in Community Behavioral Health (i.e. Program Integrity, Contracting, Clinical and Provider Operations) to resolve claims/encounter issues.
• Provider technical assistance to providers by training, weekly claim review meetings and developing reports.
• Review encounters to resolve any issues. Work with Business Rules Management Team on addressing encounter errors. This encompasses but is not limited to performing extensive research, following up with providers, creating tickets for tracking and working within other CBH department to resolve the issues.
• Perform administrative duties such as facing, mailing, scanning, emailing, copying, filling and other duties assigned by management.

Position Requirements:

• Education: Bachelor’s degree preferred or minimum of 5 years of claims experience.
• License/certification: N/A
• Relevant Work Experience: Minimum of 3 years of experience, preferably in claims and/or customer service role.
• Understanding of EDI and TPL is preferred
• Proficiency in Word, Excel and Powerpoint
• Proficiency in working with Claims and Clinical Databases
• Strong Analytical skills.
• Effective interpersonal and customer service skills
• Strong organizations skills.
• Ability to multi-task in a fast-paced environment.

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at [email protected]