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Freelance Claims Analyst II

Care1st/ONECare is looking for an experienced claims analyst to join its team. We offer flexible start times and the additional opportunity for telecommuting from home. Care1st/ONECare is committed to continually developing our people and offering chances for ongoing professional growth.

GENERAL SUMMARY: Analyzes and adjudicates health benefit claims and performs other related work as required or assigned.

QUALIFICATIONS:

•High school diploma or GED.

•3-4 years of claims processing (AHCCCS preferred)

•Knowledge in CPT and ICD-9 codes and medical terminology

•Experience in Medicaid and Medicare guidelines.

•Process all HCFA and UB claims.

•Analytical skills to resolve complex claims.

•Multi-tasked and the ability to identify and trend processing/billing issues.

•Must be organized with a positive attitude.

•Ability to work as a team player in a professional environment.

•Communicate effectively and tactfully in both oral and written form.

•Excellent attendance a must

ESSENTIAL DUTIES AND RESPONSIBILITIES:

•Accurately adjudicate claims in accordance with health plan guidelines, company standards,

and company procedures

•Maintain minimum production standards as set by Care1st policies

•Maintain a 98% or above accuracy rate.

•Review claims for appropriate information and accurate reimbursement.

•Prioritizes and manages individual workflow as needed

•Maintain completed and updated set of resource materials necessary for processing claims

•Will attend all company-mandated training and remain current with knowledge in the claims

field

•Assist with data entry of claims as needed

•Other duties as assigned

Skills / Requirements

CORPORATE INTEGRITY:

•Understands and abides by all departmental policies and procedures as well as

the organization’s Corporate Integrity Program.

•Attends mandatory Corporate Integrity Program education sessions, as required

for this position, including the annual mandatory Standards of Conduct class.

•Participates actively in ensuring that all state and federal rules and

regulations are followed as they apply to this position.

•Abides by all applicable laws and regulations as mandated by state and

federal laws and prevents being excluded or sanctioned from any state and/or

federal programs as they pertain to healthcare.

Important Notes

Employer Posted:Thursday, July 17, 2008