State of Montana Claims Analyst Lead (07010) in Helena, Montana
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.
Some key responsibilities include:
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 inquires 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.
Physical and Environmental Demands:This position works in a typical office environment with extensive keyboarding.
Required for the_first day of work_:
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.
Required Minimum Education and Experience:
Bachelor’s degree in accounting, business administration, health administrative services, health information management, economics, or a closely related field of study.
Three years of job-related work experience with medical billing and claiming Medical claims adjudication.
One year of lead worker work experience.
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.
/Women (and/or) minorities may be under-represented in this position and are encouraged to apply./
For a full copy of the job description, please contact Kaley Argee atKaley.Argee2@mt.gov.
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.
*This position is posted as ongoing, with the first review of applications on March 31, 2021. *
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/
/Successful applicant(s) are required to successfully pass all DPHHS specific background check(s) relevant to each position./
Title: Claims Analyst Lead (07010)
Requisition ID: 21140055