Claims Analyst Team A + Department: HA - Claims + Entity: Health Alliance + Job Category: Clerical/Admin + Employment Type: Full - Time + Job ID: 45246 + Experience Required: 1 - 3 Years + Education Required: Not Indicated + Shift: Day + Location: Champaign, IL + Usual Schedule: M-F 8-5 with some flexibility + On Call Requirements: no + Work Location: HA at The Fields + Weekend Requirements: no + Holiday Requirements: no Email a Friend Save Save Apply Now Position Summary: The Claims Analyst accurately processes medical, dental, orthodontia and pharmacy claims for timely payment to providers and members. Must be able to interpret and apply a wide variety of provider reimbursement methodologies, benefit plan designs, employer/member contracts and Medicare pricing methodologies. Qualifications: EDUCATIONAL REQUIREMENTS None Specified CERTIFICATION & LICENSURE REQUIREMENTS None Specified EXPERIENCE REQUIREMENTS One (1) year medical claims adjudication, healthcare billing or healthcare customer service experience. SKILLS AND KNOWLEDGE Ability to organize, prioritize and remain flexible is essential in order to meet turnaround times and performance guarantees. Knowledge of medical, dental and pharmacy benefits; medical and dental terminology; provider contracting, Medicare reimbursement methodologies, Explanation of Benefits, familiar with healthcare coding requirements (ICD-9, ICD-10, CPT, CDT, HCPCS) and legislation, and claim billing forms (CMS1500, UB04, dental claim form, as well as electronic billing formats). Essential Functions: + Adjudicates claims at a high level of productivity and accuracy as measured by individual weekly performance audits. + Prioritizes, manages and balances workload daily utilizing pended claim reports, paper claim sorting and balancing to ensure performance guarantees are met and payment of interest is avoided. + Corresponds as required by legislation and claim policies with providers and members by letter and phone on occasion to notify member and provider of claim denials or missing information. + Researches and analyzes miscellaneous document submissions to effectively determine course of action and impact to pended or finalized claims. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.