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Claims Analyst Lead
Montana Department of Public Health and Human Services

Location: Helena, Montana
Work Setting: Non Provider Setting
Job Function:
Reimbursement/ Billing Specialist
Job Type:
Full-Time
Salary Range: 52353.6

Introduction

This position is responsible in overseeing the workflow and processing of Health Resources Division claims to ensure efficient reimbursement to enrolled Montana Healthcare Programs’ providers. This position will work to plan, organize, and lead the division claims resolution specialists, and coordinate with representatives outside the agency, and members of the public by providing accurate information in an efficient manner.

Job Description

Coordinates with management to provide cross training to all Division Claims Resolution Specialists; provides training and guidance on policies and methods, including priorities, making referrals to appropriate sources of information.

Delegates work to claims resolution specialists, reviews claims processing for accuracy, adequacy and timeliness, and provides direction and training to staff.
Oversees advanced claim inquiries and assists claims staff with responding appropriately as needed.

Researches coverage and reimbursement issues and recommends solutions. Recommends medical coding, changes to administrative rules, and changes to Medicaid reimbursement system (MMIS).

Prepares File Updates Requests (FUR), checks and approves system files for uploads and makes recommendations for system changes (customer services requests (CSRs)) based on federal changes, errors, etc.

Prepares denial letters citing appropriate federal and state law, and coding guidelines for appealed claims.

Assist with writing Claim Jumper articles and provider notices related to claims adjudication and code updates.

Submits code updates or system changes for management approval.

Act as a resource to other Medicaid staff in the proper use of medical coding systems and accessing and using the MMIS and Health-e-Analytics.

Act as the Subject Matter Expert during Administrative Reviews and Fair Hearings related to claims adjudication.

Required Qualifications

Advanced knowledge and skills in medical terminology, HCPCS/CPT, and ICD-9/ICD-10 required.

Strong analytical skills, including the ability to analyze and organize data.
Strong attention to detail.

Excellent organizational, oral presentation and written and verbal communication skills.

Proficiency in MS Office products, including PowerPoint, Excel and Word.

Ability to provide effective leadership and direction within an organization.

Three years of job-related work experience with medical billing and claiming Medical claims adjudication.

One year of lead worker work experience.

Education Qualifications

Bachelor’s degree in accounting, business administration, health administrative services, health information management, economics, or a closely related field of study.

Registered Health Information Technician (RHIT) or a Certified Coder with extensive background in coding and claims processing.

Other combinations of related education and experience may be considered on a case-by-case basis.

Compensation/Benefits

The State of Montana offers a comprehensive benefits package, which includes:

15 paid vacation days
12 sick days
10 paid holidays a year

To view State of Montana’s medical, dental, vision coverage, and other offerings, you can visit our Health Care and Benefits website at, https://benefits.mt.gov/

Instructions for Resume Submission

In order to be considered for this position, you must submit a cover letter, resume, and additional references at the time of submitting the online application.

Apply Online: https://mtstatejobs.taleo.net/careersection/iam/accessmanagement/login.jsf?lang=en&redirectionURI=https%3A%2F%2Fmtstatejobs.taleo.net%2Fcareersection%2Fapplication.jss%3Flang%3Den%26type%3D1%26csNo%3D2%26portal%3D101430233%26reqNo%3D281761%26isOnLogoutPage%3Dtrue&TARGET=https%3A%2F%2Fmtstatejobs.taleo.net%2Fcareersection%2Fapplication.jss%3Flang%3Den%26type%3D1%26csNo%3D2%26portal%3D101430233%26reqNo%3D281761%26isOnLogoutPage%3Dtrue

Posted: March 5, 2021 at 11:18 AM
Post ID: 59116

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