Claims Technical Support Analyst

The Claims Technical Support Analyst is responsible for coordination between Finance, Claims, and EDI to help manage Eligibility and Provider Data issues with payers. This position works with external payer partners (and third-party administrator vendors) to facilitate error resolution and data processing with the data coming in from various trading partners and payers. Essential Functions:

• Facilitates timely reconciliation of member eligibility files with delegated payers and communications actions as needed to impacted stakeholders.
• Actively manages the ECC (eligibility, claims, compare) reports and communicates status as needed
• Collaborates on maintaining accurate provider roster data as appropriate. PCP changes, anomaly issues, and effective dates
• Enters and maintains provider and contract data in EZCap System. Utilizing and understanding a variety of supporting tools (e.g. Standard Data Roster (SDR), NPPES)
• Provides EZCap Provider Data support to all Utilization Management (UM) and Claims staff and others as needed.
• Performs audits of provider demographic information as needed.
• Maintains compliance of turn-around times as required by UM and Claims.
• Ensures compliance with PSW policies and procedures with special emphasis on compliance with HIPAA requirements.
• Prepares executive level reporting to reflect status of member eligibility and financial impacts for consideration
• Assist in development and management of active Provider Database for contracted Ancillary, PCPs & Specialists for the generation of various reports.
• Assist in research of provider-related issues including demographic information, contracting status, credentialing status, claim issues and status in various databases.
• Maintain and update the appropriate databases and department tools with statuses.
• Work collaboratively with internal departments to ensure department goals and requirements are being met.
• Supports management of vendor contract database to inform decisions, audits and renewals.
• Ensures staff compliance with PSW policies and procedures with special emphasis on HIPAA requirements
• Builds and leverages cross-functional collaborative relationships to facilitate a team-work oriented atmosphere and achieve company goals.
• Stays informed of industry trends and actively participating in trainings provided by the company.

• Set a positive example by displaying a pleasant and approachable demeanor and always remaining friendly and courteous.
• Proactive team player, strong follow through, quick decision-making abilities and abilities to problem solve.
• Interpersonal skills, with the ability to build strong relationships at all levels.
• Strong verbal and written communication skills with customers, supervisors, and co-workers.
• Strong organizational, time management and prioritization skills.
• Self-starter. Ability to set priorities and keep to projected schedules.
• Excellent computer proficiency (MS Office - Word, Excel and Outlook) including being able to effectively maintain written and computer records in accordance with regulatory agencies.

Required Education and/or Work Experience:

• Three to five years’ experience in a health plan setting, physician group setting or hospital setting (Equivalent combination of education and experience will be considered)

Preferred Education and/or Work Experience:

• Bachelor’s degree

Pulled from the full job description

• Tuition reimbursement
• 401(k)
• Health insurance
• 401(k) matching
• Paid time off
• Vision insurance
• Health savings account, * 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance