Claims Analyst III (Medicare -- Remote)
at AMERIGROUP Corporation in Florida
Under general supervision, evaluates advanced level claims to determine the type and amounts of benefits payable. Performs all authorized duties in the processing of claims allocated to the assigned market consistent with all applicable company and departmental policies.
- REMOTE POSITION (MUST LIVE 75 MILES OR MORE AWAY FROM TAMPA OFFICE) ***
- MEDICARE EXPERIENCE NEEDED **
1. Responsible for processing all advanced level claim transactions.
2. Accurately interprets, understands and applies Medicare contracts.
3. Meets or exceeds established quality and production standards.
4. Prepares and submits daily production reports in a timely manner.
5. Works with other departments to resolve issues.
6. Periodically runs system queries as necessary.
7. Adheres to company and departmental policies and procedures, as well as HIPAA regulations.
8. Responsible for preparing correspondence, maintenance of phone logs & contact logs, as well as project resolution for all markets.
9. Ability to understand and implement appropriate claims processes and courses of action when adjudicating claims, to include new day claims, claims requiring research, claims requiring adjustments and claims associated with other health insurance coverage.
10. Receive all Coordinator of Benefits (COB) claims and information with COB indicators and process claims according to coordination of benefits guidelines.
11. Ability to interpret and communicate explanation of benefits (EOB) statements from other carriers to facilitate coordination of coverage.
12. Other duties as assigned.
EDUCATION AND EXPERIENCE:
Required: High school diploma or GED.
Preferred: College Degree or some additional college level courses
Years and Type of Experience
Required: Minimum of five years medical claims processing experience or, demonstrated proficiency as an AMERIGROUP Claims Analyst II.
Specific Technical Skills
• Intermediate to advanced level Microsoft Office skills.
• Advanced understanding of medical terminology, claims coding, and standard claims forms used for physician and hospital billings.
• Excellent reading comprehension and writing skills, to include the ability to apply step by step procedures to various situations and make logical decisions based upon general instructions.
• Understanding of intermediate/advanced level mathematical concepts and the use of a calculator (i.e. calculating percentages, use of multiplication and division in calculating appropriate benefits payable, use of 10-Key)
• Excellent analytical/problem Solving Skills.
• Knowledge of state guidelines and regulations applicable to Medicare.
Certifications or Licensure
• Strong interpersonal skills
• Demonstrates initiative; is proactive in problem resolution; ability to multitask and shift focus when needed
• Able to work independently and use reference material to resolve claims related questions.
• # Direct Reports NA
• # Indirect Reports NA
• Budgetary $ Responsibility NA
• Claim Payment Responsibility
• Must be able to operate a computer, telephone and fax machine
• Data entry using repetitive motion
• Must be able to participate in meetings
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
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