Work From Home Jobs (Remote) In San Jose @Jobsextraincome ( Claims Analyst )

Hiring Organization: Bright Health

Post Name: Claims Analyst

Qualification: Graduate

Industry: Private

Employment Type: Full Time

Work Hours: 8 Hours

Salary: $20 – $30/Hour

Location: California, USA

Full Job Description

• Our Mission is to Make Healthcare Right. Together. Built upon the notion that with the aid of using connecting and aligning the satisfactory neighborhood sources in healthcare transport with the financing of care, we will supply a advanced purchaser enjoy, decrease costs, and optimized medical outcomes.
• What drives our mission? The business enterprise values we stay and breathe each day. We maintain it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
• If you proportion our ardour for converting healthcare so each person can stay healthy, brighter lives – practice to enroll in our team.

Work From Home Jobs (Remote) In San Jose @Jobsextraincome ( Claims Analyst )

SCOPE OF ROLE

The Claims Analyst assists with the oversight of claims processing, coordinating and growing reports, verifying records on submitted claims, reviewing coverage to decide which expenses are eligible for compensation, and auditing any vendor-processed claims. They make certain all commercial enterprise regulations set with the aid of using the Plan are observed and that bills are made in line with CMS suggestions, company contracts, and plan advantage designs. The Claims Analyst participates in audits, coordinating with Compliance and Legal to make certain Bright Health Plan gives all of the asked records, navigates structures as wanted for the duration of an audit, and gives any follow-up asked with the aid of using auditors.

ROLE RESPONSIBILITIES

• The Claim Analyst task description is supposed to factor out foremost duties withinside the role, however it isn't always restricted to those items.
• Partner with Configuration Provider Data, Network, and companies to make certain claims are paid to vendors and individuals accurately.
• Monitor guidelines and approaches for claims.
• Develop and display every day, monthly, and advert hoc reporting (declare reports, report elderly reports)
• Act as a liaison among Operations, Finance, Compliance, IT, company network, and different departments serving as declare SME.
• Serve all stakeholders via non-stop tracking and auditing of declare processing, academic and problem-fixing guide
• Maintain every day touch with operations management, medical leadership, and suitable business enterprise leaders
• Handle detrimental and politically hard situations, as price accuracy has a tremendous effect at the monetary overall performance of the corporation and our vendors, procedures associated with claims processing, and controlled care negotiations at the side of without delay impacting the monetary overall performance of the Plan
• Read, interpret, and formulate complicated laptop gadget regulations and controlled care compensation price methodologies along with however now no longer restricted to CMS price regulations and necessities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School degree or GED required; Bachelor's Degree preferred.
• Previous claims processing enjoy preferred.
• Three (3) years of enjoy withinside the software of CMS claims and billing suggestions required.
• Three (3) or extra years of enjoy in a controlled care corporation, fitness plan, IPA, or MSO enjoy required.
• Intermediate or superior Excel competencies for records evaluation required.

PROFESSIONAL COMPETENCIES

• Able to create and keep robust running relationships.
• Complex problem-fixing competencies.
• Able to control sources in a matrix environment, speaking and influencing efficiently in any respect tiers of the corporation.
• Broad information of medical insurance and offerings transport and functions.
• In-intensity information of federal, state, and CMS-primarily based totally necessities and the cappotential to develop, distribute and administer Medicare applications in a compliant manner.
• Success dealing with more than one projects and priorities simultaneously.
• Able to quantify the effect and ROI of projects.
• Experience in authorities applications along with Exchanges, Medicare, and/or Medicaid.
• Experience with integrating fitness plan guide offerings and different factors of operations in a high-increase environment.

Work From Home Jobs (Remote) In San Jose @Jobsextraincome ( Claims Analyst )