Claims Review Analyst (Temporary)-Remote Option

**Position is temporary, Not eligible for benefits, and will last up to 6 months. Will work up to 20 hours per week**

Primary Purpose of Position: This position is to ensure accurate and efficient processing of claims to determine whether they fall under the behavioral or physical health category.

Role and Responsibilities:

• Serves as a Reviewer to determine whether they fall under the behavioral or physical health category.
• Provide research detail needed for complex claim reviews.
• Serves as a resource for internal staff to resolve issues related to behavioral or physical health determination.
• Serves as a skilled taxonomy specialist to determine behavioral or physical health classification.

Knowledge, Skills and Abilities:

• Comprehensive knowledge of claims procedures and methods
• Working knowledge of the Medicaid Waiver requirements, HCPCS, revenue codes, ICD10, CMS 1500/UB04 coding, compliance and software requirements used to adjudicate claims
• Computer proficiency, including the use of Word and Excel programs
• Strong organization skills
• Ability to independently handle daily decision making
• Ability to handle large volume of work and to manage a desk with multiple priorities
• Ability to speak and write professionally
• Ability to work in a team atmosphere and in cooperation with others and be accountable for results
• Ability to read printed words and numbers rapidly and accurately
• Ability to understand oral and written instructions
• Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules
• Ability to maintain confidential information

Education and Experience Required: Associate Degree in Accounting or Business and five (5) years of experience in claims processing in a healthcare setting; or an equivalent combination of education and experience.

Education and Experience Preferred:

Licensure/Certification Requirements: None