• Claims Analyst

    Trinity Health (Livonia, MI)


    Employment Type:

    Full time

    Shift:

    Description:

    Claims Analyst

    **Location:** Trinity Health PACE Corp Michigan, Livonia, MI

    **Status:** Full time

    **Shift:** 730 am to 4 pm or 8 am to 430 pm

    **Work** **Type:** HYBRID, will work in the office each Wednesday.

    Position Purpose:

    The Claims Analyst is responsible for analyzing and reviewing claims for accuracy, completeness and eligibility. Prepares and maintains reports and records for processing.

    Position Details:

    HYBRID work environment – remote 4 days a week and on site one day a week.

    What you will do:

    + Analyze medical claims and review billing information. Refer claims for further investigation if needed.

    + Document and investigate claims before payment. Review paid claims for accuracy.

    + Resolve claim discrepancies with third-party billers.

    + Manage fee schedules in the software system.

    + Communicates with Interdisciplinary teams regarding unauthorized services.

    + Submit enrollments, disenrollments, and plan changes to CMS.

    + Submits data to CMS to ensure compliance with all reporting requirements.

    + Reviews and analyzes claims loss and expense reserves established by insurance carriers.

    + Act as liaison between insurance carriers and broker.

    + Performs pre-admission screening and concurrent reviews on patient records

    Minimum Qualifications:

    + High school diploma or equivalent required. Bachelor's degree preferred.

    + Familiarity with ICD-9-CM, ICD-10-CM, and CPT coding required.

    + 1-3 years of claims, adjusting, or billing experience preferred.

    + Experience with Medicare reimbursement rules and CMS-1500 & UB-04 claims preferred.

    + Previous experience with PACE Health Plan Operation, preferred.

    + A combination of education and experience may be acceptable.

    + Must be action-oriented, customer-focused, able to manage conflict and adapt to change.

    + Strong organizational, problem-solving, and communication skills.

    + Proficiency with Microsoft Office; knowledge of other relevant software.

    + Ability to work independently and exercise judgment.

    + 10% travel to other Trinity Health locations required.

    Position Highlights and Benefits:

    + Comprehensive benefit including 1st Day medical coverage, dental, vision, paid time off, 403B and educational assistance.

    + Access to daily pay and employee referral incentives.

    + Supportive environment with a patient-centered focus.

    + Opportunities for professional development.

    Ministry/Facility Information

    **Trinity Health PACE** provides high-quality care to seniors in the communities we serve. Our interdisciplinary team offers comprehensive services, allowing seniors to remain independent at home.

     

    We are guided by core values of reverence, commitment, safety, justice, stewardship, and integrity.

     

    Our Commitment to Diversity and Inclusion

     

    Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

    Our Commitment to Diversity and Inclusion

    Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

     

    Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

     

    EOE including disability/veteran