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Claims Management - Claims Analyst

Eden Prairie, MN, USA Req #512
Monday, June 7, 2021

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
 

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

 

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are.  Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.


Peak TPA is a third party administrator (TPA) that provides back-office functions for capitated health plans. Back-office functions include but are not limited to claims adjudication, member enrollment and reporting, and financial reporting. Peak TPA's partner company, Mediture/Cognify, has a long history in providing software solutions for managing care coordination for capitated health plans. Both companies (subsidiaries of Tabula Rasa Healthcare Company) work closely together to provide integrated and intuitive products to our health plans.


Peak TPA's goal is to seamlessly handle our client’s back-office functions to allow the plan to financially thrive and grow so they can focus on member care coordination.


CLAIMS ANALYST


SUMMARY:


Under supervision of the Claims Manager, the Claims analyst is responsible for processing claims and meeting defined quality and productivity standards.


ESSENTIAL FUNCTIONS:


Claims Processing and Payment


  • Evaluates claims for completeness and validity to determine payment/denial according to provider contracts, authorizations, Medicare processing guidelines and mandated government and state regulations

  • Processes various Medicare and Medicaid claim types, including Professional, Facility and Dental claims

  • Ensures timely delivery of claims and payment to client providers

  • Accurately analyzes and interprets provider contracts

  • Researches claims and makes appropriate adjustments

  • Responds to clients’ inquiries related to claims processing


ADDITIONAL FUNCTIONS:


  • Communicate clearly and concisely, with sensitivity to the needs of others

  • Maintain courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups (internally and externally); consistently cooperates and supports organization in problem solving issues; ensures customer satisfaction by understanding and applying best practices, procedures and standards of the organization; support the success of the entire team

  • Follows all Policies and Procedures and HIPAA regulations

  • Maintains a safe working environment

  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees

  • Establishes and maintains effective working relationships with co-workers

  • Participates in any recommended or required training sessions

  • Participates in special projects as requested


QUALIFICATIONS:


  • High School Diploma or equivalent.

  • PACE plan management and/or claims processing experience required.

  • Requires working knowledge of ICD-10, UB04, 1500, CPT, Revenue and HCPCS coding, along with understanding of APC and DRG reimbursement

  • Requires strong knowledge of current computer technology, including the use of computers; Intermediate level of knowledge and proficiency with associated software, including Word, Excel and Outlook.

  • Skilled in establishing and maintaining effective working relationships with co-workers and clients

  • Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency

  • Detail-oriented with ability to focus for extended periods

  • Ability to work independently, seeking supervision as needed

  • Ability to communicate professionally, clearly and effectively, verbally and in writing

  • Ability to meet attendance requirements to effectively fulfill all functions of the position

  • Ability to independently follow through on assigned tasks, without prompting

  • Ability to prioritize effectively

  • Ability to multitask



Supervisory Responsibility: None.


Travel: Minimal travel, less than 10% is expected for this position. For remote positions, travel is required for initial training and for necessary, subsequent training. Travel may also be required for company events.


Expected Hours of Work: This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Normal business hours are typically between 8:00 a.m. to 5:00 p.m.



Physical Demands:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.


  • Required to talk and hear by way of the telephone with participants, customers, vendors and staff

  • Operates a computer and other office machinery such as copy machine, fax machine, office printer.

  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy.

  • Frequent, repetitive use of hands/fingers entering information on a keyboard

  • Remains stationary for extended periods of time

  • Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects

  • Occasional reaching to retrieve shelved items or bending to access file cabinets



Environment: This job operates in a home-office environment, or professional, dress for your day, office environment with a conversational noise level. No substantial exposure to adverse environmental conditions is expected. Moderate pressure to meet scheduled appointments and deadlines. Potential for occasional verbal aggression by clients and vendors.




Tabula Rasa HealthCare, Inc. is an Equal Opportunity Employer.


Employment is contingent upon a successful background/drug check.


The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Other details

  • Pay Type Hourly
  • Travel Required No
  • Eden Prairie, MN, USA