BendRecruiter Since 2001
the smart solution for Bend jobs

Claims Analyst III

Company: PacificSource Health Plans
Location: Bend
Posted on: July 14, 2019

Job Description:

Accurately interprets benefit and policy provisions for group, individual, conversion, and COBRA medical policies. Reviews and researches medical claims and determines coverage based on contract, provider status and claims processing guidelines. Adjudicates claims for payment or denial within PacificSource standards for quality and production. Processes all types of claims, including inpatient hospital. Provides training and mentoring to new hires, as well as Claims Analysts I and II.Essential Responsibilities:

  • Work in assigned workflow role(s) to process Government professional and hospital claims.
  • Work in assigned system interfaces to review, reprocess and report on claim issues.
  • Track and report on system issues, provider billing trends and overall claim discrepancies.
  • Accurately interpret benefit and payment provisions applicable to plan enrollees.
  • Review and resolve claim and system edits using multiple systems, processes and procedures.
  • Apply appropriate pricing guidelines and job aids for professional and hospital claims requiring manual pricing.
  • Research and apply Medicare National and Local Coverage Determinations.
  • Use ‘Notes' system to record pertinent information with attention to detail involving a claim or member.
  • Work independently under time pressure, and maintain company compliance by resolving and processing claims within the guidelines established by regulatory agencies and the plan.
  • Document and report issues that affect claims processing or accuracy to claims leadership team.
  • Identify and report suspected instances of fraud, waste and abuse to claims leadership team.
  • Follow HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Be a resource to level I and II claims analysts.
  • Assist as needed to maintain compliance with company and regulatory standards. Supporting Responsibilities:
  • Assist in the development of departmental procedures and training materials.
  • Assist with training of new analysts.
  • Regularly attend team meetings and daily team Visual Board huddle.
  • Work collaboratively in an objective, professional, and diplomatic manner with all parties involved in a workgroup or project.
  • Meet department and company performance and attendance expectations.
  • Perform other duties as assigned. Work Experience: Minimum of two years PacificSource work experience as a claims analyst or equivalent work experience in a related health field. Education, Certificates, Licenses: High school diploma or equivalent required. Knowledge: Basic-intermediate proficiency in Microsoft Office Applications including Word and Excel. Knowledge of medical terminology and medical coding required. Knowledge of claims, authorization, and provider network required. Knowledge of Medicare and Medicaid including coverage and pricing methodologies preferred. Excellent Time Management, Critical Thinking and Research skills preferred. Competencies Our Values · Building Customer Loyalty· Building Strategic Work Relationships
  • Contributing to Team Success
  • Planning and Organizing· Continuous Improvement· Adaptability· Building Trust· Work Standards
    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for customer service.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our many communities-internally and externally.
    • We encourage creativity, innovation, and the pursuit of excellence. Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Keywords: PacificSource Health Plans, Bend , Claims Analyst III, Professions , Bend, Oregon

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Professions Jobs


Recent Grad CDL-A Truck Driver - Earn More!
Description: Recent CDL-A Grads: Don't have enough experience to get the truck driving job you want No worries, come join us You will spend 165 hours behind the wheel with
Company: C.R. England
Location: Bend
Posted on: 07/19/2019

CDL-A Team Company Truck Driver - Refrigerated / OTR
Description: TEAM CDL-A TRUCK DRIVER JOBS OTRWhen You re Ready For Your Truck Driving Team To Make Top Miles, You Can Count On Kennesaw.Take your CDL-A truck driving team to employee-owned Kennesaw Transportation, (more...)
Company: Kennesaw Transportation
Location: Eugene
Posted on: 07/19/2019

Entry-Level Truck Drivers Class A CDL
Description: We Train, We Hire - Guaranteed br At C.R. England, we train new drivers and hire experienced drivers. We are seeking truck drivers that have a safe and
Company: C.R. England
Location: Eugene
Posted on: 07/18/2019


12N Horizontal Construction Engineers
Description: Before a road, airfield, or a building can be constructed, all obstacles must be removed from the site. As a Horizontal Construction Engineer in the Army National Guard, you'll handle the heavy lifting (more...)
Company: Army National Guard
Location: Albany
Posted on: 07/19/2019

Recent Grad CDL-A Truck Driver - Earn More!
Description: Recent CDL-A Grads: Don't have enough experience to get the truck driving job you want No worries, come join us You will spend 165 hours behind the wheel with
Company: C.R. England
Location: Eugene
Posted on: 07/18/2019

CDL A Truck Drivers - $3,000 Sign-On Bonus!!
Description: Get on the Road and Get Home this Summer br br br Andrus provides you more time to be with those you care about br most, all while making exceptional pay and benefits br - Solo Driver - br (more...)
Company: Andrus Transportation
Location: Albany
Posted on: 07/19/2019

Driver - Team Truck Driver - Class A CDL
Description: APPLY ONLINE BELOW OR CALL 855 548-2691 TODAY br br Team truck driver compensation is among the highest in Schneider's fleet. Earn up to 0.55 per mile starting pay and average 5,000-6,000 miles (more...)
Company: Schneider
Location: Albany
Posted on: 07/19/2019

We Train New Truck Drivers!
Description: We Train, We Hire - Guaranteed br At C.R. England, we train new drivers and hire experienced drivers. We are seeking truck drivers that have a safe and
Company: C.R. England
Location: Eugene
Posted on: 07/18/2019

Team Owner Operator, Terminal to Terminal
Description: br br Forward Air over-the-road LTL: The foundation product for Forward Air is our over-the-road LTL service. In LTL you will run our trailers no trailer fees , drop hook from one Forward Air (more...)
Company: Forward Air
Location: Eugene
Posted on: 07/18/2019

CDL A Lease Purchase Reefer Truck Drivers - Earn Up To $2,100 Weekly!
Description: American General Transport is looking for CDL A OTR Lease Purchase Truck Drivers What We Offer: Reefer Transport Company that runs all 48 states Take
Company: American General Transport
Location: Eugene
Posted on: 07/18/2019

Log In or Create An Account

Get the latest Oregon jobs by following @recnetOR on Twitter!

Bend RSS job feeds