The Medical Claim Analyst will join the Provider Coding and Reimbursement (PCR) team to review provider coding and reimbursement denial disputes.
This role involves reviewing provider resubmissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix, and DRG claims, then resolving them or preparing them for review by an Aetna clinician. The analyst will also review provider rework claims according to claim processing and PCR guidelines, research claims in internal systems, and document claim history in Aetna systems.
Requirements & Qualifications
Required Qualifications
- Extensive knowledge of the Aetna ACAS claims platform
- At least 1 year of ACAS claim processing experience
- Ability to review claims and perform rework
- Experience with EWM, ASD, and ECHS
- Knowledge of systems including IFP and HRP for exchange support
- Ability to work in Excel spreadsheets when needed
- Strong communication and collaboration skills
- Ability to work independently and as part of a team
- Ability to prioritize work and manage multiple deadlines
- Ability to meet quality, turnaround, and productivity expectations
Preferred Qualifications
- ACAS/EWM experience strongly preferred
- Claims processing experience
- Strong analytical and technical skills
- Knowledge of benefit plans, policies, and procedures
- Ability to handle multiple assignments accurately and efficiently
- Strong attention to detail
Education
- High school diploma, GED, or equivalent experience
Benefits & Perks
Full-time employees are eligible for a comprehensive benefits package that may include:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources based on eligibility
Location
Miami, Florida, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
3 weeks ago
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