1 Medicare Claims Analyst Job in Little Rock, AR
SORT BY
A
Medicare Claims Analyst
$43k-53k (estimate)
Full Time | Insurance
1 Week Ago
Arkansas Blue Cross Blue Shield is Hiring a Medicare Claims Analyst Near Little Rock, AR
To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.Workforce Scheduling
Remote
Job SummaryThe Medicare Program Analyst is accountable for maintaining an ongoing assessment and interpretation of the Federal Regulations which pertain to both the Medicare Advantage and Prescription Drug programs. The Analyst must assure the efficient and effective delivery of services by third party administrators (TPA). The Analyst must also monitor operational compliance. The Analyst must be able to research, track and resolve complex issues involving several entities and programs.
RequirementsEDUCATIONHigh School Diploma required.
Bachelor's degree in Business, English, or Healthcare Management related field. In lieu of degree, five (5) years' health related experience with health insurance, pharmacy, managed care, or healthcare related organization will be considered.
ExperienceMinimum three (3) years' Medicare analysis and/or research experience.
Minimum two (2) years' experience in monitoring vendors for accuracy and ensuring compliance.
Must have served as project lead on one (1) large scale project and have successful completion of the project (e.g. implementation, issue tracking and resolution).
Successful completion of three (3) enterprise courses that are related to leadership or personal development.
Proficient working knowledge of PC programs including experience with MS Office Suite.
Medical Claims Experience Preferred.Pharmacy Claim experience preferred.
Prescription Drug Program Experience Preferred.Medicare Advantage experience preferred.
Project Management Experience Preferred.Experience in the area of extensive problem solving preferred.
Public speaking experience preferred. Demonstration of public speaking ability will be required during the interview process.
Essential Skills & AbilitiesSuperior planning and coordinating skills
Proficient analytical skills and methodologies
Requires proficient interpersonal skills, including public speaking ability in order to make presentations to internal staff, CMS, auditors, etc.
Ability to effectively and efficiently communicate on a professional scale, both written and verbal communications.
Ability to work independently.
Ability to organize and coordinate workloads for maximum efficiency.
Ability to prepare a project plan, participate or lead special projects.
Ability to research and review several different issues from operational areas, coordinate with various operational owners to find a resolution, track the resolution to completion. This may be demonstrated via an assignment during the interview process.
Ability to interpret requests from operational areas, and summarize changes needed in a clear and professional format, for a variety of audiences. This will be demonstrated via an assignment during the interview process.
SkillsResponsibilities
Liaison for maintaining professional relationships between the enterprise and its partners involved in the processing of the MediPak Advantage and MediPak Rx programs., Monitor, analyze and ensure operational compliance of various vendors for both Medicare Advantage and Prescription Drug Program. Operations include but are not limited to: Marketing, Enrollment, Member Communications, Billing, Medical Claims, Prescription Drug Claims, etc., Research, track and resolve escalated issues regarding these programs.
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:
Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.Workforce Scheduling
Remote
Job SummaryThe Medicare Program Analyst is accountable for maintaining an ongoing assessment and interpretation of the Federal Regulations which pertain to both the Medicare Advantage and Prescription Drug programs. The Analyst must assure the efficient and effective delivery of services by third party administrators (TPA). The Analyst must also monitor operational compliance. The Analyst must be able to research, track and resolve complex issues involving several entities and programs.
RequirementsEDUCATIONHigh School Diploma required.
Bachelor's degree in Business, English, or Healthcare Management related field. In lieu of degree, five (5) years' health related experience with health insurance, pharmacy, managed care, or healthcare related organization will be considered.
ExperienceMinimum three (3) years' Medicare analysis and/or research experience.
Minimum two (2) years' experience in monitoring vendors for accuracy and ensuring compliance.
Must have served as project lead on one (1) large scale project and have successful completion of the project (e.g. implementation, issue tracking and resolution).
Successful completion of three (3) enterprise courses that are related to leadership or personal development.
Proficient working knowledge of PC programs including experience with MS Office Suite.
Medical Claims Experience Preferred.Pharmacy Claim experience preferred.
Prescription Drug Program Experience Preferred.Medicare Advantage experience preferred.
Project Management Experience Preferred.Experience in the area of extensive problem solving preferred.
Public speaking experience preferred. Demonstration of public speaking ability will be required during the interview process.
Essential Skills & AbilitiesSuperior planning and coordinating skills
Proficient analytical skills and methodologies
Requires proficient interpersonal skills, including public speaking ability in order to make presentations to internal staff, CMS, auditors, etc.
Ability to effectively and efficiently communicate on a professional scale, both written and verbal communications.
Ability to work independently.
Ability to organize and coordinate workloads for maximum efficiency.
Ability to prepare a project plan, participate or lead special projects.
Ability to research and review several different issues from operational areas, coordinate with various operational owners to find a resolution, track the resolution to completion. This may be demonstrated via an assignment during the interview process.
Ability to interpret requests from operational areas, and summarize changes needed in a clear and professional format, for a variety of audiences. This will be demonstrated via an assignment during the interview process.
SkillsResponsibilities
Liaison for maintaining professional relationships between the enterprise and its partners involved in the processing of the MediPak Advantage and MediPak Rx programs., Monitor, analyze and ensure operational compliance of various vendors for both Medicare Advantage and Prescription Drug Program. Operations include but are not limited to: Marketing, Enrollment, Member Communications, Billing, Medical Claims, Prescription Drug Claims, etc., Research, track and resolve escalated issues regarding these programs.
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Insurance
SALARY
$43k-53k (estimate)
POST DATE
05/20/2024
EXPIRATION DATE
06/15/2024
WEBSITE
arkansasbluecross.com
HEADQUARTERS
TEXARKANA, AR
SIZE
1,000 - 3,000
FOUNDED
1948
REVENUE
$1B - $3B
INDUSTRY
Insurance
Related Companies
About Arkansas Blue Cross Blue Shield
For 70 years, Arkansas Blue Cross and Blue Shield has been a trusted partner to Arkansans by providing reliable insurance plans while also being a valuable community partner. We live here, work here and raise our families here we are dedicated to Arkansas and to you. We work hard to improve the health, financial security and peace of mind to the members and communities we serve. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association.
Show more
Similar Jobs
Popular Articles
Top 10 Things to Avoid Putting on a Job Application
Read Article
How to Describe Your Education in a Resume
Read Article
How to Write a Memorable Cover Letter in 5 Ways
Read Article
4 Personal Finance Tips to Make During Job Transition
Read Article
4 Best Camera Setups for Interview
Read Article
Keeping a Job Search Journal: 9 Types of Journaling You Can Do
Read Article
