HEALTH CARE ANALYST

Date: Jul 8, 2024

Req ID: 41347

Location:

Little Rock, AR, US, 72201

Category: AR DEPT OF HUMAN SERVICES

Anticipated Starting Salary: $32,404.94

Position Number: 22112145
County: Pulaski
Posting End Date: 7/28/2024
Anticipated Starting Salary: $32,404.94
DMS
Hiring Official: Jamie Ward

Must have skills: Knowledge of state and federal laws and regulations and agency policy governing health care. Knowledge of medical insurance claims procedures. Knowledge of medical terminology and records. Ability to analyze medical claims and reports in accordance with established criteria. Ability to interpret and apply state and federal laws and agency policy governing health care. Ability to prepare and present verbal and written information, correspondence, and reports. Experience working with Microsoft Excel, analyzing data, and working with Medicaid or other insurance programs.

· Receive and review various types of Beneficiary appeals

· Serve as clerical support to Appeals and Hearing Unit staff for all processes within the unit.

· Provide technical assistance to requesting parties by researching policy and procedure information and answers questions per protocol

· Prepare specialized reports, as needed

· Fax, scan, and email appeal documents, as needed

· Communicate with administrative law judges, attorneys, contractors, other units, agencies,providers, and recipients according to agency office policy and procedural guidelines

· Assure HIPAA security compliance with all case file documents

· Create 3383 Retrospective Review provider letters requesting EOMB (Explanation of Medicare Benefits) and prepare for mailing

· Assist with Audit 3383 Retrospective Review paid claims-Medicare Advantage Crossover Claims- paper and electronically- to ensure provider billed correctly.

· Log 3383 reviews completed by each UR staff as assigned

· Verify number of completed reviews weekly, transfer files to scanning lab to be entered in Docushare.

· Verify 3383 reviews are scanned correctly into DocuShare and logged

· Multitask in a professional manner to meet changing priorities

· Provide additional support for 3383 Retrospective Review Audit as needed.

The Department of Human Services is a place for people passionate about serving others and changing lives for the better. We care for Arkansans of all ages and ensure places like child care centers and nursing homes are safe. We are the safety net for the most vulnerable Arkansans. Whether you answer the phones, take applications, protect children, or help care for residents or patients at one of our facilities, you make a difference by working at DHS. Plus, working for the State has great perks, including a pension, maternity leave, paid state holidays, and much more. At DHS, we take care of our employees so you can help care for others.

Position Information

Class Code: L070C

Grade: GS05

FLSA Status: NON-EXEMPT

Salary Range: $32,405.00 - $46,987.00

Summary

The Health Care Analyst is responsible for examining provider and recipient insurance claims and records, identifying and resolving payment problems under the Medicaid system, and coordinating staff and program activities. This position is governed by state and federal laws and agency/institution policy.

Functions

Examines claim forms, computer files, and other records to ensure compliance with claim requirements, determine eligibility status, and/or identify and resolve problems with claim payments. Reports irregularities of insurance claim payments to supervisor and prepares correspondence regarding findings to notify involved parties. Interviews involved parties to obtain additional or clarifying information and documents interview and paperwork or medical records. Approves or denies claim based on information, initiates changes to computer files, maintains log of corrections, and notifies involved parties of corrections or status of claim. Provides technical assistance to requesting parties by researching claim, disseminating eligibility and policy and procedure information, answering questions regarding claim status, and updating provider pricing schedules. Conducts regular or special surveys and studies, compiles data, analyzes information, and prepares related reports. Performs other duties as assigned

Dimensions

None

Knowledge, Skills and Abilities

Knowledge of state and federal laws and regulations and agency policy governing health care. Knowledge of medical insurance claims procedures. Knowledge of medical terminology and records. Ability to analyze medical claims and reports in accordance with established criteria. Ability to interpret and apply state and federal laws and agency policy governing health care. Ability to prepare and present verbal and written information, correspondence, and reports.

Minimum Qualifications

The formal education equivalent of a bachelor's degree in general business, business education, office management systems, management, or a related field; plus one year of experience in documents examination, claims examination, or a related field. OR The formal education equivalent of an associate degree in office occupations, business education, business management, or a related field; plus three years of experience in documents or claims examination or a related field. Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management. OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.

Licenses

None

The State of Arkansas is committed to providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, pregnancy, age, disability, citizenship, national origin, genetic information, military or veteran status, or any other status or characteristic protected by law.