American Specialty Health, Inc. is looking for an experienced Claims Compliance Analyst to join our Claims team. This position reviews member denials for accuracy and generate denials letters as needed. This position is responsible for HCFA and Commercial Member denial letters and IPA letters and to ensure state and regulatory agency claims processing compliance guidelines are met.

Hourly Salary Range

American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate's qualifications, education, skill set, years of experience, and internal equity. $14.70 to $17.00 Hourly Wage Range.

Remote Worker Considerations
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).

Responsibilities

• Researches accuracy of member denials prior to releasing letters.
• Releases claims pended for member denial letters upon completion of audit tool.
• Assists in the preparation for health plan audits, including assembling support materials and copying of claims and claims reports.
• Provides assistance and teamwork to Claims Department staff in accomplishment of department objectives.
• Runs Claim related queries.
• Assist Claim Analysts and QR Analysts, as needed, to accomplish quality reviews, adjustments & special contract claim processing.
• Assist with claim processing as needed.
• Assists in the accomplishment of special projects.
• Maintains confidentiality of all claims files, audit reports, and related claims data.

Qualifications

• AA degree or equivalent preferred. High school diploma required.
• Achieved progression to Level II Claims Examiner for internal Claims candidates, or minimum 2 years experience performing claims processing or analyst/research duties.
• Proficient in MS Office with experience developing and maintaining reports in Access and Excel.
• Knowledge of CMS, DMHC, state and health plan specific claim requirements, CPT codes, ICD-9 codes, and medical terminology.
• Familiarity with Managed Care, HMO, PPO health plan provisions.
• Strong analytical, problem solving, and verbal and written communication skills.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

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