[Hiring] Claims Analyst @Medavie

Role Description

The Claims Analyst - Alternate Funding Program is responsible for a wide variety of claim types under the Alternate Funding Program within Medicare. Each claim type has a varying degree of eligibility and policy requirements. The Claims Analyst will analyze, investigate, and pay medical claims which include the payment of locum, sessional, psychiatry and various other claims. Additionally, they are required to maintain current knowledge with respect to policy and procedure changes. The successful candidate will work with the leadership team and colleagues to help ensure exceptional customer service is provided to the Nova Scotia Department of Health and Wellness, and our provider and resident stakeholders.

• Review, analyze and set up payment data based on contracts forwarded from the Department of Health & Wellness.
• Maintain and reconcile contract payments to physicians using standard procedures.
• Adjudicate and apply data entry functions for all alternate funding programs and billings from physicians with a strong emphasis on accuracy and efficiency.
• Liaise with Physicians, support staff and various stakeholders in a professional manner with respect to system use, claims submissions, and payment reconciliations.
• Review applications from the Boarding, Transportation and Ostomy Program as well as the Locum Program to determine eligibility.
• Support the update and development of business area procedures, including developing proper training material and support systems.
• Perform quality assurance checks on claims adjudication to ensure payment accuracy and consistency among staff.
• Support Escalations for claims adjudication in a calm manner with a sense of urgency, liaising with internal and external partners to support resolution of concerns.

Qualifications

• Post-secondary education in Business Administration, Accounting, Finance or other related field; a combination of education and experience may be considered.
• Knowledge and training in Medical Terminology.
• 3+ years of relevant experience would be an asset.
• Able to adapt in a changing and fast-paced environment with the ability to accept and implement changes.
• Possess a high attention to detail and a high level of accuracy.
• Analytical in nature with proven problem-solving skills and an aptitude for mathematics.

Requirements

• Experience working in a PC setting with multiple software applications (i.e., MS Office Suite: Excel, Word, Power Point).
• Strong keyboarding skills and the ability to enter data with speed and precision.
• Excellent communication skills by way of verbal, written, and electronic medium.
• High level of accuracy with attention to details while maintaining the ability to complete assigned tasks and meet deadlines.
• Ability to set and work through a list of priorities in a timely manner.
• Develop the business knowledge and experience required to solve routine problems.
• Demonstrates a willingness to learn while working collaboratively to achieve common goals.
• English required, French is considered an asset.

Benefits

• Permanent full-time position with opportunity to grow in a well-established organization.
• Flexible work arrangements and emphasis on work-life balance.
• Remote and hybrid work options.
• Comprehensive health, vision and dental plan that is 100% employer paid effective on your first day.
• 100% employer-matched Defined Contribution Pension Plan.
• Annual Incentive Bonus which recognizes your contribution to our success.
• In addition to paid vacation, we offer a gifted week of vacation in your first year and an optional Vacation Purchase Program.
• An organization where we encourage personal learning and growth with opportunities for career development.