Job ID: NC-652457 (93690603)
Healthcare BA/Claims Processor with MMIS, NCTracks/payment system, rules, claims, regulatory and MS Office experience
Location: Raleigh, NC (NCDHHS)
Duration: 12months
Interview: Either Webcam Interview or In Person
Positions:1(1/1)
Skills :’
Experience working with NC MedicaidRequired
Experience with NCTracksRequired
Experience working with claims adjudication/reprocessingRequired
Experience with gathering requirementsRequired
An understanding of claim edits and auditsRequired
Strong organizational, time management, communication, and detail-oriented skillsRequired
Excellent communication, negotiation, conflict resolution and persuasion abilitiesRequired
Strong understanding of health care strategy, operations, technology, and regulatory requirementsRequired
Position Overview:
This position will serve as a member of the Business Technology Relationship Management team. The unit is responsible for managing relationship between the DHB program/functional areas and the Technology that supports the business and supports all of the division.
Job Specific Responsibilities
Review of various claims reports to perform in-depth claim analysis, validation of system changes, and review of edits/audits in order to make recommendations to maintain the integrity of the reprocessing.
Provide incident monitoring, problem ticket, incident creation and troubleshooting.
Defect Resolution
Requesting System Enhancements
Preferred Knowledge, Skills, and Abilities:
Experience working with NC Medicaid
Experience with NCTracks
Experience with gathering requirements
Experience working with claims adjudication/reprocessing
An understanding of claim edits and audits
Strong understanding of health care strategy, operations, technology, and regulatory requirements
Demonstrated ability to work independently in a fast-paced environment with concurrent deadlines
Excellent communication, negotiation, conflict resolution and persuasion abilities
Strong organizational, time management, communication, and detail-oriented skills
Highly proficient with Microsoft Outlook, Word and Excel