Reimbursement Analyst II

Role Description

• Seeking strong work ethic and hard workers who are willing to learn.
• Success in this position depends on your ability to think independently, evaluate information critically, and adapt processes when needed.
• Remote: Work from almost anywhere in the US with a 100% remote setup.
• Schedule: Monday to Friday, with typical day shift hours from 8:00 AM to 5:00 PM CST.
• Holiday Coverage: Some flexibility could be needed for holiday coverage depending on business needs.

Ensure accurate and timely payment of claims to providers. Utilize research and knowledge of coverage and benefits to ensure resolution to more difficult claim payment issues.

• Submit accurate and timely payments to providers, keeping within contractual service level agreements for each market.
• Develop and maintain controls over the proprietary processed data and systems set up through developing and implementing auditing procedures, and identifying potential claim audit exposures.
• Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
• Assure that claims are paid within the expected time frames by monitoring inventory control and working with team members and appropriate resources in other areas to resolve issues related to claims entry.
• Identify trends and suggest and develop efficiencies in the review of edit reports and other documentation by reviewing procedures and making appropriate suggestions and adjustments to procedures.
• Resolve complex claim payment inquiries by analyzing patient activity and related documentation (including enrollment, claims, and authorizations) and determine appropriate action to be taken.
• Resolve complex client issues that may require research, analysis and working with management.
• Complete requests for claims review and/or reprocess within internal guideline turnaround times.

Qualifications

• High school diploma or equivalent
• 2 years of prior job related experience (Dental Assistant, Dental/Medical Office Manager, Dental/Medical front office, or health/dental insurance, including managed care operations, accounts receivable and or billing)
• Knowledge of health or dental procedures coding and terminology.
• Basic knowledge of Microsoft software (Outlook, Excel and Word).
• Exceptional written and verbal communication skills.

Requirements

• Bachelor’s Degree in a related field

Benefits

The salary range is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.