Claims Management Analyst

Salary Range: $63,080 - $82,792

This is an exempt position. Pay rates are based on education, skill, experience level and internal equity.

Position Summary

Performs research and analysis for claims management within the finance department. This position works independently and is responsible for managing projects, advising management on results and recommending necessary adjustments to department procedures. The successful candidate will have knowledge of revenue cycle principles as well as federal, state, and local healthcare coding and billing rules and regulations.

Essential Functions

• Analyze claim data to ensure proper reimbursement and advises management of results
• Monitor and analyze all referred accounts to determine categorization, level of the appeal process, and personally handle complex appeal responses for private health care, government-specific denials, and recommend necessary adjustments to department procedures
• Work under the guidance of department management on strategic projects to include assisting in the establishment of goals and objectives
• Respond to requests from State, County, local municipality government, external partners such as payers, external clinicians or community stakeholders
• Manage various projects aligned with Strategic Business Plan goals
• Gather and organize information about the problem to be solved or the procedure to be improved
• Meet with program leaders and conduct on-site observations to develop training materials implement quality assurance processes, and to serve as a resource to internal departments, financial institutions, and external agencies
• Analyze financial and other data; including, but not limited to, revenue, expenditure, and insurance payer reports
• Develop solutions or alternative practices
• Recommend new systems, procedures, or organizational changes
• Make recommendations to management through presentations or written reports
• Confer with managers to ensure that the changes are successfully implemented and creating positive results
  
  

Minimum Qualifications

Experience: Minimum of two years’ experience in a related field.

Education: Bachelor’s degree in Business Administration, Public Administration, Data Analytics or a related field.

Combination of relevant education and relevant experience accepted: Yes

LICENSES AND CERTIFICATIONS

• May require a valid North Carolina or South Carolina Driver’s License
• May require County Driving Privileges
  
  

Preferred Qualifications

• Master’s degree in Business Administration, Public Administration, Data Analysis or a related field.
• Certified Professional Coder (CPC) certification from AAPC
  
  

Knowledge, Skills And Abilities

Knowledge of

• Accounting principles
• Medical terminology, ICD-10, CPT, and HCPCS codes
• Principles and processes for providing customer and personal services; this includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction
• Business and management principles involved in strategic planning, project management, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources
• Structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
  
  

Skills

• Data management and data visualization
• Understanding written sentences and paragraphs in work related documents
• Talking to others to convey information effectively
• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions
  
  

Abilities

• Job / Organizational Fit: The extent to which activities and responsibilities available in the job are consistent with the activities and responsibilities that result in personal satisfaction; the degree to which the work itself is personally satisfying; the extent to which an organization’s mode of operation and values are consistent with the type of environment that provides personal satisfaction.
• Technical / Professional Knowledge & Skills: Having achieved a satisfactory level of technical and professional skill or knowledge in position-related areas; keeping up with current developments and trends in areas of expertise
• Managing Work: Effectively managing one’s time and resources to ensure that work is completed efficiently
• Building Strategic Relationships: Developing and using collaborative relationships to facilitate the accomplishment of work goals
• Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements or cultures
• Information Monitoring: Setting up ongoing procedures to collect and review information needed to manage an organization or ongoing activities within it
• Collaboration: Working effectively and cooperatively with others; establishing and maintaining good working relationships
• Active Listening: Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate
  
  

Computer Skills

Advanced proficiency in various computer applications including Microsoft Office Suite

REASONABLE ACCOMMODATIONS STATEMENT

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

DISCLAIMER STATEMENT

This is not intended to be an all-inclusive list of job-related responsibilities, duties, skills, requirements or working conditions. Other duties may be assigned based on business need and the supervisor’s request. Mecklenburg County reserves the right to revise the job description at any time. Designated positions may be required to assist in emergency and/or disaster situations.