Claims Analyst
SoGal Ventures
Livonia, MIFull-timePosted todayStill listed today
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Job overview
The Claims Analyst analyzes medical claims for accuracy, completeness, and eligibility, investigates and documents claims, and resolves discrepancies with third-party billers. The role manages fee schedules, communicates with interdisciplinary teams, submits enrollment and reporting data to CMS, reviews insurance reserves, and performs patient-record reviews. This hybrid position is based in Livonia, with remote work four days a week and office work each Wednesday.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Employment Type: Full time
Shift: Day Shift
Location: Trinity Health PACE Corp Michigan, Livonia, MI
Status: Full time
Shift: 8 am to 4:30 pm
Work Type: HYBRID, will work in the office each Wednesday.
Position Purpose: The Claims Analyst is responsible for analyzing and reviewing claims for accuracy, completeness and eligibility. Prepares and maintains reports and records for processing.
Position Details: HYBRID work environment
remote 4 days a week and on site each Wednesday. Must live within commutable distance to office in Livonia.
What You Will Do
Analyze medical claims and review billing information. Refer claims for further investigation if needed.
Document and investigate claims before payment. Review paid claims for accuracy.
Resolve claim discrepancies with third-party billers.
Manage fee schedules in the software system.
Communicates with Interdisciplinary teams regarding unauthorized services.
Submit enrollments, disenrollments, and plan changes to CMS.
Submits data to CMS to ensure compliance with all reporting requirements.
Reviews and analyzes claims loss and expense reserves established by insurance carriers.
Act as liaison between insurance carriers and broker.
Performs pre-admission screening and concurrent reviews on patient records
Minimum Qualifications
High school diploma or equivalent required. Bachelor's degree preferred.
Familiarity with ICD-9-CM, ICD-10-CM, and CPT coding required.
1-3 Years Of Claims, Adjusting, Or Billing Experience Preferred.
Experience with Medicare reimbursement rules and CMS-1500 & UB-04 claims preferred.
Previous Experience With PACE Health Plan Operation, Preferred.
A combination of education and experience may be acceptable.
Must be action-oriented, customer-focused, able to manage conflict and adapt to change.
Strong organizational, problem-solving, and communication skills.
Proficiency with Microsoft Office; knowledge of other relevant software.
Ability to work independently and exercise judgment.
10% travel to other Trinity Health locations required.
Position Highlights And Benefits
Comprehensive benefit including 1st Day medical coverage, dental, vision, paid time off, 403B and educational assistance.
Access to daily pay and employee referral incentives.
Supportive environment with a patient-centered focus.
Opportunities for professional development.
Ministry/Facility Information
Trinity Health PACE provides high-quality care to seniors in the communities we serve. Our interdisciplinary team offers comprehensive services, allowing seniors to remain independent at home.
We are guided by core values of reverence, commitment, safety, justice, stewardship, and integrity.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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