Job Description

Employment Type:

Full time

Shift:

Day Shift

Description:

Claims Analyst

Location: Trinity Health PACE Corp Michigan, Livonia, MI

Status: Full time

Shift: 8 am to 430 pm

Work Type: HYBRID, will work in the office each Wednesday.

Position Purpose:

The Claims Analyst is responsible for analyzing and reviewing claims for accuracy, completeness and eligibility. Prepares and maintains reports and records for processing.

Position Details:

HYBRID work environment – remote 4 days a week and on site each Wednesday. Must live within commutable distance to office in Livonia.

What you will do:

• Analyze medical claims and review billing information. Refer claims for further investigation if needed.
• Document and investigate claims before payment. Review paid claims for accuracy.
• Resolve claim discrepancies with third-party billers.
• Manage fee schedules in the software system.
• Communicates with Interdisciplinary teams regarding unauthorized services.
• Submit enrollments, disenrollments, and plan changes to CMS.
• Submits data to CMS to ensure compliance with all reporting requirements.
• Reviews and analyzes claims loss and expense reserves established by insurance carriers.
• Act as liaison between insurance carriers and broker.
• Performs pre-admission screening and concurrent reviews on patient records

Minimum Qualifications:

• High school diploma or equivalent required. Bachelor's degree preferred.
• Familiarity with ICD-9-CM, ICD-10-CM, and CPT coding required.
• 1-3 years of claims, adjusting, or billing experience preferred.
• Experience with Medicare reimbursement rules and CMS-1500 & UB-04 claims preferred.
• Previous experience with PACE Health Plan Operation, preferred.
• A combination of education and experience may be acceptable.
• Must be action-oriented, customer-focused, able to manage conflict and adapt to change.
• Strong organizational, problem-solving, and communication skills.
• Proficiency with Microsoft Office; knowledge of other relevant software.
• Ability to work independently and exercise judgment.
• 10% travel to other Trinity Health locations required.

Position Highlights and Benefits:

• Comprehensive benefit including 1st Day medical coverage, dental, vision, paid time off, 403B and educational assistance.
• Access to daily pay and employee referral incentives.
• Supportive environment with a patient-centered focus.
• Opportunities for professional development.

Ministry/Facility Information

Trinity Health PACE provides high-quality care to seniors in the communities we serve. Our interdisciplinary team offers comprehensive services, allowing seniors to remain independent at home.

We are guided by core values of reverence, commitment, safety, justice, stewardship, and integrity.

Apply now!

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.