Job title: Analyst, Accumulator
Company: Evolent Health Services
Job description: It’s Time For A Change Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We
It’s Time For A Change Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans. Are we growing Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized Definitely. We have been named one of ‘Becker’s 150 Great Places to Work in Healthcare’ in 2016, 2017, 2018 and 2019, and one of the ’50 Great Places to Work’ in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it. What You’ll Be Doing: Evolent is looking individuals to work as Associates, Accumulators in claims teams Essential functions Proficient level adjudicator providing strong analytical skills to review claim rules and workflows Responsible for adjudicating claims to maintain and reconcile the members accumulators Ensuring timeliness and accuracy in reprocessing claims and reconciling of member accumulators Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, DRG and Rev Codes, etc.) Research CMS1500 and UB claim edits to determine appropriate benefit application utilizing established criteria Multiple surgery review Apply physician contract pricing as needed Apply hospital/facility contract pricing as needed (including DRG) Process high dollar claims Resolve member/provider inquiries in a timely manner as it relates to member accumulators Review and resolve provider/member appeals and disputes as it relates to member accumulators Review insurance policies to determine valid coverage Demonstrate a strong attention to detail and commitment to customer service throughout the claims process Adjust claims benefit payments on the Evolent computer system including manual calculations of complex items and manual adjustment to the system as needed to correctly adjudicate claim benefit payment for plan benefits enrollment contracts, reimbursement schedule, provider contracts, and referral authorization. Performs in depth analysis of complex claims identifying missing and/or incomplete data to determine appropriate resolution. Coordinating with different departments and ensuring the success of file transfers and loading of data. Skill Set Requirements Extensive experience in health insurance claims processing with a minimum of 2 years in claim processing experience. In-depth knowledge of medical billing and coding Knowledge of health insurance, HMO, Medicare, Medicaid, Commercial and managed care principles Extensive knowledge and understanding of member accumulators – Individual and family cost share, Copay’s, Co-insurance, deductibles and Out of pocket maximums Experience working in Excel with different files formats (CSV, TXT) and analyzing data Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products Ability to handle daily workload with speed and accuracy Excellent interpersonal, oral, and written communication skills Able to work independently, strong analytic skills Comfort using and learning new technology. Academic Qualification Associate or bachelor’s degree preferred. Extensive experience in health insurance claims processing with a minimum of three years of actual experience preferredWork Environment:
Location: Pune, Maharashtra
Job date: Fri, 11 Mar 2022 23:44:58 GMT
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