JOB TITLE: Remote Medical Processing
JOB LOCATION: Remote
WAGE RANGE*: $20hr to $22hr/ W2 ONLY
JOB NUMBER: 25-02989

REQUIRED EXPERIENCE:

Bachelor's degree in Business, Healthcare Administration, Finance, or a related field; OR 3-5 years of experience in medical claims posting and reconciliation.
Background in medical processing or claims is preferred. Needs to have mid-level proficiency in Excel. Working knowledge of SQL would be helpful.

JOB DESCRIPTION

We are seeking a highly motivated and detail-oriented Operations Business Analyst to join our team. This position is responsible for the daily posting and accounts receivable (AR) reconciliation of medical payments to claims, based on both paper and electronic Explanation of Benefits (EOBs) from insurance carriers. The analyst will correct errors, modify posting issues, and generate monthly invoices based on claims processed during the reporting period.

This role requires strong problem-solving skills, the ability to work independently in a remote environment, and experience in healthcare claims. The ideal candidate will be comfortable navigating complex systems and processes and have a deep understanding of medical and pharmacy claims adjudication, Medicaid reclamation, and healthcare payment cycles.

Key Responsibilities:

* Post payments to medical and pharmacy claims from paper and electronic EOBs daily.
* Reconcile AR and correct any discrepancies or posting issues.
* Identify, analyze, and resolve errors in claim postings and payments.
* Participates in meetings with client engagement to gather and document requirements and explore potential solutions.
* Assists in analyzing and documenting client's business requirements and processes following established approach and methodology; communicates these requirements to technical personnel.
* Plans and designs standard business processes following established approach and methodology; assists in formulating recommendations to improve and support business activities.
* Develops and modifies systems requirements documentation to meet client needs.
* Generate and distribute monthly invoices using PeopleSoft Finance based on claims posted during the reporting period.
* Create, run, and deliver posting and reconciliation reports; analyze trends and anomalies.
* Use FTP protocols to securely transfer files from various sources.
* Maintain accurate documentation for audit and compliance purposes.
* Collaborate with other departments to resolve issues related to claims and payments.
* Work independently in a remote environment while meeting deadlines and service level agreements (SLAs).

Required Qualifications:

* Bachelor's degree in Business, Healthcare Administration, Finance, or a related field; OR 3-5 years of experience in medical claims posting and reconciliation.
* Solid understanding of medical and pharmacy claims adjudication and Medicaid reclamation claims.
* Proficiency in SQL and ability to extract and analyze data from relational databases.
* Familiarity with PeopleSoft Finance or similar enterprise financial systems.
* Strong critical thinking and problem-solving skills; able to troubleshoot independently.
* Experience with FTP protocols and secure file transfer.

Preferred Qualifications:

* Experience working with healthcare data analytics or reporting tools.
* Prior experience in a remote or hybrid work environment.
* Knowledge of healthcare payment cycles and insurance reimbursement processes.

Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities

* While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions.PDN-9f2dec81-6a92-4023-a544-46e832a1d80c