Job Description

As a Claims Analysts you will play a key role in Guidehealth’s expansion and growth. You will be responsible for the adjudication of claims that require high level review and investigation according to plan requirements. Maintain an average daily quantity and quality production requirement. This position will report to the Manager, Claims.

What you’ll be doing

• Adjudication of medical healthcare claims that PEND during the auto adjudication process for high level review.
• Maintain daily production requirements meeting the federal prompt pay turnaround times.
• Meet or exceed a quality score of greater than 95%.
• Exceed the minimum required per hour claim production.
• Complete the weekly pre-adjudication audit reports for payment accuracy prior to weekly check cycles.
• Attend weekly 1:1’s with manager for continued feedback conversations.
• Attend monthly team meetings.
• Communicate system issues to the manager for further investigation and JIRA ticket entry.
• Other duties as assigned.

Qualifications

What you’ll need to have

• Minimum 1-3 years’ claims processing experience, preferably from both the payer and provider side.
• CPT and ICD coding knowledge.
• Ability to work independently and prioritize tasks to meet deadlines.
• A clear understanding of coding requirements ie: CPT and ICD codes and medical terminology.
• Intermediate to advanced understanding of Microsoft Office products ie: Excel, Word, Access etc.
• Able to problem solve, exercise initiative, and make role level decisions.
• Thorough understanding of claims processing compliance requirements.
• Ability to meet deadlines and prioritize tasks and assign work daily to the staff.
• Ability to work independently with minimal supervision.
• Effective written and oral communication.

What we’d love for you to have

• Certified Professional Biller (CPB), Certified Professional Coder (CPC), or other similar certifications.
• Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus.

Additional Information

** The base pay range for this role is between $19- $23.57 per hour paid bi-weekly**

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.