CLAIMS COORDINATOR

Position Number: 22098586
County: Pulaski
Posting End Date: [[postingEndDate]]
Anticipated Starting Salary: $57,351.01
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Preferred qualification: Certified Professional Coder

Description:

• Analyze diverse data sets for purposes of identifying fraud, waste and abuse in the Medicaid program
• Compare and cross-reference Medicaid claims data with other data sources to identify fraud, waste and abuse
• Perform basic to intermediate claims data analysis, including filtering and aggregating large datasets, identifying trends and outliers, comparing provider billing patterns, calculating financial impacts, and developing audit samples
• Review and analysis of medical records, licensure, employment records, and financial statements
• Evaluate patterns and practices of provider use of CPT, HCPCS, ICD-10-CM, modifiers, units of service, and place of service codes in different program areas to identify potential waste and abuse
• Create spreadsheets, visual data representations, and executive summaries to communicate trends, issues, and data-based conclusions
• Research and identify applicable Arkansas Medicaid policy
• Prepare executive summaries, reports, charts and other materials for communicating results of data analysis in plain language
• Assist with developing new data-driven approaches to identifying and recovering overpayments
• Perform compliance audits as needed

Position Information

Job Series: Program Operations – Claims Administration

Classification: Claims Coordinator

Class Code: PCA01P

Pay Grade: SGS07

Salary Range: $57,351 – $84,879

Job Summary

The Claims Coordinator is responsible for managing and organizing the claims process to ensure accurate, efficient, and timely resolution of insurance claims. This role involves serving as a central point of communication between claimants, insurance providers, and internal teams, as well as maintaining records, monitoring claim statuses, and facilitating resolutions. The Claims Coordinator plays a vital role in streamlining operations and ensuring customer satisfaction by ensuring claims are handled in a professional and compliant manner.

Primary Responsibilities

Coordinate the entire claims process, from initial reporting to resolution, ensuring efficiency and accuracy. Serve as the primary liaison between claimants, insurance adjusters, healthcare providers, legal teams, and internal personnel. Review and verify claim documentation for completeness and compliance with policy terms. Monitor claim statuses and maintain up-to-date records in claims management systems. Investigate claim details, identify discrepancies, and resolve issues in collaboration with a variety of assorted personnel. Communicate updates and outcomes of claims to relevant parties in a clear and timely manner. Assist in developing and implementing process improvements for better claims handling. Ensure adherence to agency policies, industry standards, and regulatory requirements. Prepare reports and summaries on claims data and trends for management review.

Knowledge and Skills

Strong organizational and multitasking abilities. Excellent verbal and written communication skills for interacting with a variety of assorted personnel. Attention to detail and the ability to analyze and resolve discrepancies. Knowledge of insurance policies and regulations is advantageous. A customer-focused and problem-solving mindset is essential.

Minimum Qualifications

Bachelor’s degree in business administration, insurance, healthcare administration, or a related field.

Minimum of 4 years of experience in claims coordination, claims management, customer service, or related fields.

Satisfaction of the minimum qualifications, including years of experience and service, does not entitle employees to automatic progression within the job series. Promotion to the next classification level is at the discretion of the department and the Office of Personnel Management, taking into consideration the employee’s demonstrated skills, competencies, performance, workload responsibilities, and organizational needs.

Licensure/Certifications

N/A OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.

The State of Arkansas is committed to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, pregnancy, age, disability, citizenship, national origin, genetic information, military or veteran status, or any other status or characteristic protected by law.