Profile
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!
We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)
Job Summary
The Coding & Reimbursement Analyst supports claims payment accuracy and waste reduction initiatives by collecting, aggregating, and analyzing claims data from multiple systems. This role requires documenting, reporting, and communicating information, as well as performing claims data analysis to mitigate risks while identifying patterns and trends. The Coding & Reimbursement Analyst has a strong understanding of claims coding and payment methodologies as well as data analytics. This position is responsible for turning claims adjudication and provider billing data into meaningful information, which Claims Admin leadership will use to make informed decisions to improve claims quality, efficiency, and Government contract(s) adherence.
Required
Education & Experience
- Bachelor's degree in Business Administration, Finance, Healthcare, Information Management or equivalent experience
- 3 years’ experience in healthcare analysis, data management or equivalent
- 3 years’ experience in a claims environment, with a strong knowledge of CMS coding and reimbursement methodologies
- Proficient in Microsoft Office suite, with an emphasis in Excel and data analysis and reporting
Preferred
- Quality or Process Improvement experience
- Experience with data visualization tools such as Tableau, Power BI, etc.
- Working knowledge of structured query language (SQL), and SQL Reporting Services (SRS)
- Government claims experience
- Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
Key Responsibilities
- Acquires claims data from primary or secondary data sources.
- Identifies, analyzes, and interprets trends or patterns in complex claims data sets.
- Develops visualizations and presentations to summarize and explain claims data findings or quality issues.
- Evaluates the completeness and accuracy of claims data.
- Works closely with Claims Admin leadership and SMEs on process and quality improvement strategies and/or provider education efforts, resulting from claims data analyses and findings.
- Must have strong problem-solving and decision-making skills.
- Ability to define problems, collect claims data, establish facts, analyze claims data, and report the findings to appropriate stakeholders.
- Ability to collect, aggregate and disseminate data in understandable, digestible, and useful ways across the organization.
- Will effectively present claims data information and respond to detailed claims payment or coding questions from varied internal or external groups.
Competencies
Technical Skills
Advanced analytical skills; knowledge of fundamentals of accounting and sound business processes; extensive knowledge of Microsoft Excel; proficient with Word; process diagram and documentation experience preferred; research and project management skills.
Team-Building / Team Player
Influence the actions and opinions of others in a positive direction and build group commitment.
Problem Solving / Analysis
Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Organizational Skills
Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Information Management
Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions.
High Intensity Environment
Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Coping / Flexibility
Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach.
Computer Literacy
Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Communication / People Skills
Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Working Conditions
- Favorable working conditions in a climate controlled office space
- May work within an office environment
Company Overview
Taking Care of Our Nation’s Heroes.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
Benefits
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
*Annual base salary for Colorado and Washington State residents: $95,000 - $102,000 depending on experience*
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
