Clinical Data Acquisition Analyst
CareSource
SQL
Performance Analyst
Capital Blue Cross
full-time
Posted on:
Location Type: Remote
Location: Remote • Pennsylvania • 🇺🇸 United States
Visit company websiteSalary
💰 $47,800 - $91,070 per year
Job Level
Mid-LevelSenior
About the role
- Audits claims, customer service inquiries, member and group enrollment activities, product builds as well as focus and client audits as assigned
- Supports IA and SIU with assistance as needed
- Utilizing internal formatting, maintains adequate documentation to support all audit reviews and outcomes
- Providing this material to the appropriate Performance Analyst for internal and BCBSA report compilation
- Participate in team collaborative efforts to resolve audit issues
- Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented
- Completes the BCBSA LDLA Tool with the required information during LDLA reviews and provides completed work to the Reviewer for required review
- Utilizes Reviewer feedback to assure independent compliance with the Program, identifying trends and assure ongoing accuracy
Requirements
- A minimum of 5 years' experience in Claims, Membership or Customer Service (or combination of the three)
- Understanding of the healthcare industry as it relates to Capital
- Understanding of claims coding and processing including BlueCard and FEP; membership processes at both the group and member level; and customer service processes, also including FEP
- Familiar with Capital’s various product designs and their coding structures
- Familiar with Facets and FEPDirect
- Familiar with Microsoft Office applications especially Excel
- High School diploma or GED
Benefits
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off, Holidays, and Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Comprehensive benefits packing
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims codingclaims processingmembership processescustomer service processesaudit documentationdata analysistrend identification
Soft skills
collaborationcommunicationproblem-solving
Certifications
High School diplomaGED
