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Posted : Wednesday, April 10, 2024 10:16 PM
Claims Analyst
JobID: 13663
Date Posted:
11/14/2023
Location:
Finance Department
Reports to: Chief Financial Officer
Type of Position: Full - time:
Hours / Work Year: Exempt / 12 month
General Description:
The job of Claims Analyst is done for the purpose/s of providing a wide variety of analyses and support to
several departments including the departments of Curriculum and Instruction, Special
Services, Human Resources, Finance and Technology Services; analyzing and synthesizing information; monitoring budgets; processing claims; conveying information regarding department functions and procedures; establishing
and maintaining records; compiling and distributing materials and reports; and responding to inquiries from
a variety of internal and external sources.
Performance Responsibilities: Claims Processing: Your primary responsibility is processing Medicaid claims for the school district.
This involves reviewing, verifying, and submitting claims to Medicaid for reimbursement, as well as ensuring compliance with Medicaid regulation and Orphanage, McKinney Vento, Transportation.
Medicaid Compliance: Stay updated on the ever-changing Medicaid regulations and compliance requirements to ensure that all claims meet the necessary criteria and adhere to federal and state guidelines.
Human Resources Liaison: Act as a liaison between the school district's claims processing and the Human Resources department.
Collaborate with HR to ensure that employee information, such as qualifications and certifications, is accurately documented for Medicaid claims purposes.
Special Education Liaison: Similarly, serve as a liaison between Medicaid claims processing and the Special Education department.
Work closely with Special Education staff to ensure that services provided to students with disabilities are properly documented and claimed through Medicaid.
Collaboration: Foster effective communication and collaboration between various departments, such as Finance, Accounting, Human Resources, and Special Education, to streamline the Medicaid claims process.
Record Keeping: Maintain accurate and organized records related to Medicaid claims, employee qualifications, certifications, and Special Education services, ensuring accountability and compliance.
Problem Resolution: Address discrepancies or issues in Medicaid claims and work with the relevant departments (HR, Special Education, and providers) to resolve issues promptly.
Reporting and Analysis: Prepare reports related to Medicaid claims processing, budgeting, and financial planning.
Analyze data to identify trends and opportunities for cost-saving.
Budgeting and Planning: Collaborate with the relevant departments to plan and budget for Medicaid-eligible services, ensuring that financial resources are allocated efficiently.
Continuous Improvement: Continually seek opportunities to improve the coordination between the Medicaid claims process and the Human Resources and Special Education departments.
This role requires a strong understanding of Medicaid regulations, Human Resources processes, and Other duties as assigned.
Qualifications This role requires a strong understanding of Medicaid regulations, Human Resources processes, and Special Education needs.
Effective communication, attention to detail, and the ability to navigate complex regulations and relationships within the school district are essential to excel in this multifaceted position.
Bachelor's degree in a relevant field.
Advanced degrees are a plus.
5+ years of experience in claims analysis.
Demonstrated analytical and persuasive writing skills experience as well as superior editing skills, including ability to convey complex information in a clear manner to a diverse audience; Strong administrative skills and self-motivated with the ability to set priorities and manage multiple tasks under minimal supervision in effective and efficient manner; Intermediate to expert skills in Microsoft Office (specifically Word, Excel and PowerPoint) Ability to work under pressure and respond to deadlines without sacrificing quality Proven experience in grant writing, proposal development, and grant management, especially in K-12 education.
Familiarity with grant budgeting and financial management, including bookkeeping for grants.
Strong organizational and project management skills.
Exceptional communication, writing, and presentation skills.
Proficiency in grant research and grant management tools and software.
Attention to detail, ability to work independently, and meet deadlines.
Performance Responsibilities: Claims Processing: Your primary responsibility is processing Medicaid claims for the school district.
This involves reviewing, verifying, and submitting claims to Medicaid for reimbursement, as well as ensuring compliance with Medicaid regulation and Orphanage, McKinney Vento, Transportation.
Medicaid Compliance: Stay updated on the ever-changing Medicaid regulations and compliance requirements to ensure that all claims meet the necessary criteria and adhere to federal and state guidelines.
Human Resources Liaison: Act as a liaison between the school district's claims processing and the Human Resources department.
Collaborate with HR to ensure that employee information, such as qualifications and certifications, is accurately documented for Medicaid claims purposes.
Special Education Liaison: Similarly, serve as a liaison between Medicaid claims processing and the Special Education department.
Work closely with Special Education staff to ensure that services provided to students with disabilities are properly documented and claimed through Medicaid.
Collaboration: Foster effective communication and collaboration between various departments, such as Finance, Accounting, Human Resources, and Special Education, to streamline the Medicaid claims process.
Record Keeping: Maintain accurate and organized records related to Medicaid claims, employee qualifications, certifications, and Special Education services, ensuring accountability and compliance.
Problem Resolution: Address discrepancies or issues in Medicaid claims and work with the relevant departments (HR, Special Education, and providers) to resolve issues promptly.
Reporting and Analysis: Prepare reports related to Medicaid claims processing, budgeting, and financial planning.
Analyze data to identify trends and opportunities for cost-saving.
Budgeting and Planning: Collaborate with the relevant departments to plan and budget for Medicaid-eligible services, ensuring that financial resources are allocated efficiently.
Continuous Improvement: Continually seek opportunities to improve the coordination between the Medicaid claims process and the Human Resources and Special Education departments.
This role requires a strong understanding of Medicaid regulations, Human Resources processes, and Other duties as assigned.
Qualifications This role requires a strong understanding of Medicaid regulations, Human Resources processes, and Special Education needs.
Effective communication, attention to detail, and the ability to navigate complex regulations and relationships within the school district are essential to excel in this multifaceted position.
Bachelor's degree in a relevant field.
Advanced degrees are a plus.
5+ years of experience in claims analysis.
Demonstrated analytical and persuasive writing skills experience as well as superior editing skills, including ability to convey complex information in a clear manner to a diverse audience; Strong administrative skills and self-motivated with the ability to set priorities and manage multiple tasks under minimal supervision in effective and efficient manner; Intermediate to expert skills in Microsoft Office (specifically Word, Excel and PowerPoint) Ability to work under pressure and respond to deadlines without sacrificing quality Proven experience in grant writing, proposal development, and grant management, especially in K-12 education.
Familiarity with grant budgeting and financial management, including bookkeeping for grants.
Strong organizational and project management skills.
Exceptional communication, writing, and presentation skills.
Proficiency in grant research and grant management tools and software.
Attention to detail, ability to work independently, and meet deadlines.
• Phone : NA
• Location : Oswego, IL
• Post ID: 9005434459
