Full Job Title: *Claims Reporting Analyst
Job Number: 1800972
Location: Phoenix, AZ
Date Posted: 2-8-2018
This position is for Care1st Health Plan, a WellCare Healthplans, Inc. company.
Reports to: Operations Supervisor
Location: E. Camelback Rd, Phoenix AZ 85016
Job Type: Hourly/ Non-exempt
Reviews daily, weekly, and monthly reports to ensure accurate claims processing prior to adjudication. Performs data analysis and review and approval of FW&A recommendations prior to adjudication. Serves as a subject matter expert on claims adjudication for the Medicaid and Medicare lines of business within the health plan.
Required A High School or GED
Preferred An Associate's Degree in a related field
Required 3 years of experience in claims processing including COB/TPL and claim reversals and adjustments.
Required 1 year of experience in MHC claims processing
Intermediate Demonstrated analytical skills
Intermediate Demonstrated problem solving skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to multi-task
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated organizational skills
Intermediate Ability to work independently
Intermediate Demonstrated written communication skills
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Attention to detail with high level of accuracy
Beginner Basic knowledge of procedures used in fraud, abuse and waste detection and investigation
Intermediate Knowledgeable in AHCCCS and CMS rules/regulations/reference tools/policy manuals, etc.
Intermediate Detailed understanding of claims processing of institutional and/or professional claims
Required Intermediate Microsoft Excel
Required Beginner Microsoft Word
Required Beginner Microsoft Outlook