Medicaid Senior Claims Analyst

Network Health's success is rooted in its mission to enhance the life, health and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Senior Claims Analyst. This individual is responsible for complex claim adjudication. In addition, this individual will assist with training, development and process documentation within the department.

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Essential Job Duties:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies
• Resolves customer issues and inquiries in a professional and timely manner
• Assists in the training of new staff members
• Runs reports to retrieve processing information from the claims processing system
• Works directly with senior management and operations team regarding system limitations and testing issues
• Identifies and troubleshoots claims issues
• Assists Claims Management with projects, work production, claims adjustment reports, and prioritization of work activities to ensure team and department goals are obtained
• Acts as a liaison with other operational departments on workflow and processing and system opportunities
• Maintains and updates guidelines
• Monitors suspended claims reports to ensure established time frames are met
• Other Duties as assigned
  
  

Knowledge/Skills/Abilities Required:

• Strong oral and written communication skills with the ability to listen mindfully, identify gaps and ask appropriate questions
• Ability to organize one's work and space to ensure successful completion of assigned tasks within the identified timeframe
• Ability to adapt to new circumstances, information and challenges in a fast paced environment
• Ability to work independently, as well as part of a team
• Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-10).
• Medical terminology, COB processing
• Basic Word and Excel skills
• Excellent critical thing, problem solving, and decision making skills
• Excellent attention to detail and follow through
• Strong commitment to excellence in customer service with both internal and external customers
  
  

Minimum Education Required:

• HS Diploma or equivalency required
• Additional course work in Medical Terminology/Advanced Medical Terminology required
• Knowledge of Federal and State mandates and regulation related to claims and coding preferred.

Minimum Related Years of Experience (per minimum education) Required:

• 3-5 years of experience in claims processing

Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.