What are the responsibilities and job description for the Business Analyst II position at Independent Living Systems?
ABOUT US
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Business Analys II is responsible for reviewing and responding to correspondence received from Providers and for the re-adjudication of medical and hospital claims in accordance with prompt pay guidelines as well as applicable policies & procedures. In addition, the Claims Correspondence Coordinator must recognize, elevate and make recommendations to resolve issues. As well as guidance and direction to the correspondence staff giving leadership and training when needed to meet departmental and corporate goals.
Essential Functions
1.Review, research and respond to daily correspondence received from providers via phone calls, mailed inquiries and provider portal request or appeals.
2.Provide world class service to our providers and plan representatives by efficiently responding to written inquiries from providers and the plan. Addressing high level claim issues with internal departments as well as the client.
3.Examine and validate complaint data, calculate and adjudicate insurance claims in compliance with federal, state, and county laws, plan policy and Company policies and procedures.
4.Adjust finalized claims for correct reimbursement, claim corrections and errors.
5.Analyze system to identify problems / issues as they pertain to claims processing and elevate those issues to management.
6.Identify issues based on provider inquiries and elevate those issues to management.
7.Make recommendations to drive change in an effort to improve departmental service levels.
8.Review quality statistics trends: coordinate efforts with the Manager to implement necessary steps for improvement.
9.Complete projects as assigned.
10.Prepare management reports relative to state and compliance guidelines.
11.Compile statistical data; prepare reports as required.
12.Performs other duties as required or assigned.
Education and Experience
- High School Diploma/GED required; college course work preferred.
- Minimum 5 years claims examiner or related experience, with at least 2 years claim medical data analysis responsibilities
- Experience processing UB04 and CMS 1500 claims
- Self-starter, conscientious, independent worker.
- Strong knowledge of Customer Service skills and techniques required.
- Excellent written, verbal and grammatical communication skills required.
- Ability to read, interpret, analyze technical / business procedures and / or governmental regulations required.
- Ability to write reports, business correspondence and procedural manuals required.
- Knowledge of automated systems (technical adeptness) required.
- Demonstrated proficiency in Microsoft programs (ie, Excel, Word, PowerPoint) required; knowledge of Microsoft Access preferred.
Required Skills
- Ethical Conduct.
- Strategic-Critical Thinking.
- Decision Making.
- Communications Proficiency.
- Presentation Skills.
EEO STATEMENT
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
