[Hiring] Operations Analyst @Claritev

Role Description

This position assists with workflow distribution, claim research, documentation processing, and operational/service pilot projects in support of Clinical Review operations.

• Review, investigate, and analyze claim appeals, working closely with coders to coordinate review of documentation.
• Assist customer service, providers, and clients on resolution of issues or inquiries.
• Research and manage claim inventory for inpatient, outpatient, and provider billing using review guidance supplied by our clinical teams.
• Request and process documentation associated with special projects and clinical review inquiries.
• Access, research, and retrieve information and documentation from Claritev and one of various external client systems.
• Data entry and database maintenance including review, validation, and maintenance of provider data.
• Perform system claim adjustments based on appeal outcomes or to process corrected claims.
• Manage manual distribution of workflow when system is unable to assign.
• Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company’s core competencies and values.

Please note: due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.

The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Qualifications

• Minimum high school diploma or GED along with two (2) years of experience in an operations and/or service role such as claims processing, customer service, medical records, collections, data entry, or database management. Associate's degree accepted without prior experience.
• Experience in health care and/or knowledge of commonly used medical coding preferred.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Communication (written, verbal and listening), analytical, organizational, prioritization, technical, etiquette and interpersonal skills.
• Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites with preferred proficiency with Word, Excel, and other database software.
• Ability to be flexible in quickly shifting priorities and keeping up with changes across multiple tasks in a fast-paced environment while maintaining a positive and cooperative demeanor.
• Ability to demonstrate strong technical skills.
• Ability to identify issues and escalate for course of action for resolution.
• Ability to elicit trust and credibility with all levels of the organization.
• Ability to adjust or alter schedule to meet deadlines.
• Ability to work independently and handle confidential information.
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitors for extended periods of time, operating standard office equipment such as a keyboard, copier and telephone.

Requirements

• Compensation: The salary for this position is $50,000. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity.
• This position is also eligible for health insurance, 401k and bonus opportunity.

Benefits

• Medical, dental and vision coverage with low deductible & copay.
• Life insurance.
• Short and long-term disability.
• Paid Parental Leave.
• 401(k) + match.
• Employee Stock Purchase Plan.
• Generous Paid Time Off – accrued based on years of service.
• WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service.
• 10 paid company holidays.
• Tuition reimbursement.
• Flexible Spending Account.
• Employee Assistance Program.
• Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits.

EEO Statement

Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status.

Application Deadline

We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.