Medicare Part D Claims Analyst (remote) (See screening attachment) (Role has open comp)
1400 Corporate Drive Suite 225 Irving Texas 75038 United States Irving, TX 75038
Medicare Part D Claims Analyst (Remote)
Location for candidate (Texas) (Bi-Lingual)
ESSENTIAL ROLES AND RESPONSIBILITIES
- Responsible for conducting quality check and reviews of Medicare Part D claims samples on a routine basis to ensure proper Medicare Part D claims parameter computations as well as suggesting new edits or claim alerts or reviews that could be applied in real time to ensure consistent and quality claims processing for Part D clients.
- Responsible for independently researching PDE errors related to clinical program parameters on claim transitions and providing mitigating steps for error resolutions. Analyze claims processing concerns related to Part D claims processing.
- Evaluate new processing business requirements and analyze claims requirements in order to ensure technical claims solutions are achieving the desired claim adjudication results.
- Responsible for reviewing and responding to Accumen PDE Edits reviews within established timelines and communicating to plan sponsors with resolution confirmations.
- Responsible for the distribution of PDE Error Summary Reports created monthly after submissions as well as the analysis of error trends noted in reporting that would need escalation.
- Responsible for the calculation and creation of adjustment claims for processing based upon technical, clinical and client eligibility errors.
- Responsible for the daily analysis of FIR transfers for benefit changes and the identification of impacted claims for intervention and review.
- Responsible for the updating and maintenance of PDE Error Manual Processes for Plan Sponsors. Reviews manual with clients as needed to assist in client training and education on client responsibilities in the PDE error handling process.
TRAINING AND EDUCATION
- Bachelor’ s degree in finance, Information Technology or Healthcare related field; or equivalent experience.
The person must have:
- Internet accessibility with or more than 10MB speed.
- Personal cellphone.
- Personal computer.
Meet Your Recruiter
You know the outgoing person in the room who has the infectious laugh, always wears a smile, and loves a good chat, well...that's me! I aim to be a solution whether it be a staffing need for a tomorrow start or a hard to hire area. It may be possible that you're in the job market looking for a new role. My passion is people. I want to learn what drives you, your passions, and your personal career goals. If you feel you meet the qualifications listed in a job ad or would like to chat about your career plan, feel free to schedule a time to meet!