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Medicare Part D Claims Analyst - Bilingual

Company: The Judge Group
Location: Irving
Posted on: May 3, 2021

Job Description:

Location: Irving, TX Description: Our client is currently seeking a Medicare Part D Claims Analyst - Bilingual

This job will have the following responsibilities: Responsible for conducting quality check and reviews of Medicare Part D claims samples on a routine basis to ensure proper Medicare Part D claims parameter computations as well as suggesting new edits or claim alerts or reviews that could be applied in real time to ensure consistent and quality claims processing for Part D clients.
Responsible for independently researching PDE errors related to clinical program parameters on claim transitions and providing mitigating steps for error resolutions. Analyze claims processing concerns related to Part D claims processing.
Works with internal teams to define audit universe/sample requirements. Responsible for conducting quality checks and reviews of results of universe/sample pulls and preparing written analysis of testing results.
Evaluate new processing business requirements and analyze claims requirements in order to ensure technical claims solutions are achieving the desired claim adjudication results.
Responsible for reviewing and responding to Accumen PDE Edits reviews within established timelines and communicating to plan sponsors with resolution confirmations.
Responsible for the distribution of PDE Error Summary Reports created monthly after submissions as well as the analysis of error trends noted in reporting that would need escalation.
Responsible for the calculation and creation of adjustment claims for processing based upon technical, clinical and client eligibility errors.
Identification of errors relating to claims processing to isolate and mitigate resolution of issues or errors.

Keywords: The Judge Group, Irving , Medicare Part D Claims Analyst - Bilingual, Other , Irving, Texas

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