Analyst, Operations I - Remote Eligible

Operations Analyst 1

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

This position assists with workflow distribution, claim research, documentation processing, and operational/service pilot projects in support of Clinical Review operations.

Compensation: The salary range for this position is $19 - $20 Hourly. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Job Roles and Responsibilities

1. Review, investigate, and analyze claim appeals, working closely with coders to coordinate review of documentation. Assist customer service, providers, and clients on resolution of issues or inquires.

2. Research and manage claim inventory for inpatient, outpatient, and provider billing using review guidance supplied by our clinical teams.

3. Request and process documentation associated with special projects and clinical review inquiries.

4. Access, research, and retrieve information and documentation from Claritev and one of various external client systems.

5. Data Entry and database maintenance including review, validation, and maintenance of provider data.

6. Perform system claim adjustments based on appeal outcomes or to process corrected claims.

7. Manage manual distribution of workflow when system is unable to assign.

8. Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed.

9. Collaborate, coordinate, and communicate across disciplines and departments.

10. Ensure compliance with HIPAA regulations and requirements.

11. Demonstrate Company's Core Competencies and values held within.

12. Please note: due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.

13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope

This position works independently under general supervision to complete the outlined job responsibilities by applying knowledge of claims and department processes. Work involves applying advanced skills using systems and tools in support of departmental operations. Duties and tasks are focused internally on high volume processes. The incumbent resolves routine questions and issues while referring more complex issues to higher levels for resolution.