Claims/Contract Analyst   
Full Time – Johnstown, Pa

Senior LIFE is an innovative home and community based Medicare and Medicaid funded program which provides all-inclusive healthcare services and support to seniors living in the community. Senior LIFE makes it possible for seniors to remain at home, enjoying the comfort and reassurance of familiar surroundings while receiving the care they need.  Senior LIFE staff live the mission of the program.  Our team is committed to partnering with our seniors to remain at home through promoting open communication and shared decision making while providing excellent care and services.

To fulfill this mission, Senior LIFE is seeking a hardworking, dedicated and experienced Claims/Contract Analyst to join our team.

Responsibilities include:

• Act as a trouble shooter for all provider claims that error during normal processing; research claim issues to identify root cause and makes recommendations for further investigation or resolution; adjusts claims when applicable.
• Help to identify system errors and aide in resolution to prevent future errors.
• Prepares pricing packets and reviews all claims unable to process automatically through claims processing system. This includes, hospital inpatient claims, anesthesia claims, rural ambulance claims, and Ambulatory Surgical Center claims.
• Assist Provider Network Director with claims processing system maintenance to include: benefit mapping issues, fee schedule updates, CPT and Diagnosis code updates, DRGs, modifiers, denial and message codes, adding vendors or providers.
• Supports all claims department initiatives in improving overall efficiency with claims payment processing; provides additional education and training when necessary.
• Additional duties as assigned by Supervisor

Qualifications:

• Three years’ experience in healthcare finance with healthcare insurance contracts and payment methodologies as well as coding/billing/claims processing experience.
• Bachelor’s degree preferred in Finance, healthcare management, or related field.
• Knowledge of and working experience with coding, billing, and claims processing procedures.
• Understanding of healthcare terminology, insurance contract language, claims processing and Medicaid/Medicare payment policies.
• Ability to solve problems/claims issues within pre-defined methods and guidelines.
• Knowledge of operating systems specific to claims processing.
• Knowledge of Microsoft Outlook and Excel.
• Ability to interact in a positive manner with providers, coworkers, and management.
• Ability to work collaboratively with internal staff to identify and resolve claims processing errors.

EOE