Medical Claim Analyst

Job not on LinkedIn

🔥 3 hours ago

🐊 Florida, Idaho, +1 more states – Remote

🐊 Florida – Remote 🥔 Idaho – Remote 🤠 Texas – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🧐 Analyst

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician. • Prioritize work and be able to multitask to balance projected workload and due dates. • Review provider rework claims in accordance with claim processing and PCR guidelines. • Research claims in the ASD or ACAS/EWM systems. • Research and document claim history in Aetna Strategic Desktop (ASD) and Electronic Correspondence Handling System (ECHS).

🎯 Requirements

• Extensive knowledge of the Aetna ACAS claims platform and a minimum of 1 year of ACAS claim processing experience. • Ability to review claims • Rework experience, EWM, ASD and ECHS • Knowledge of functionality in systems including IFP, HRP, etc. for the exchanges support. • Work within Excel spreadsheets when needed. • Communicate and collaborate effectively with other team members and departments within Aetna. • Work independently and as part of a team. • Prioritize work and be able to multitask to balance project workload and due dates. • Provide excellent service by meeting quality, turnaround key performance metrics, and meeting productivity expectations.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs