Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.
About Our Opportunity
As a Claims Resolution Analyst, your responsibility will be to review and resolve assigned claims. You’ll ensure timely and accurate processing while adhering to contractual rates, coding guidelines, and regulatory requirements.
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Things You’ll Do Here:- Reprice and process claims based on contractual rates and guidelines. Review claim forms, verify coding accuracy, and determine the appropriate reimbursement amounts.
- Conduct a comprehensive review and evaluation of claims to ensure adherence to coding standards, medical necessity, and billing accuracy.
- Handle claims that incorporate Medicare-like or Medicare Plus pricing models. Conduct gap analysis in situations where Medicare allowable rates are not available.
- Perform research and analysis to facilitate the resolution of provider/client issues, such as claim disputes, billing inquiries, or coding concerns.
- Handle identified billing and coding edits, such as CPT codes, ICD-10 codes, HCPCS codes, and modifiers. Process claims based on contract benefits and limitations.
- Review and revise claims related to special projects, which may involve unique requirements, additional documentation, or specific guidelines.
- Ensure the timely handling of claim disputes, reversals, and appeals for all lines of business. Evaluate the validity of appeals and make decisions based on contract terms, coding guidelines, and regulatory requirements.
- Maintain compliance with company policies, procedures, and regulatory guidelines such as HIPAA. Read, interpret, and apply appropriate contract benefits and limitations to claims processing.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.
Where You’ll Work
This role is remote.
Why You Will Love Working Here
We offer employee perks that go beyond standard benefits and compensation packages – see below!
At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!
Perks and Benefits
- Generously subsidized company-sponsored medical, dental, and vision insurance
- Company-funded HRA
- 401K with company match and immediate vesting
- Flexible working environment
- Generous Paid Time Off
- Paid maternity and paternity leave
- Paid company holidays
- Community giveback opportunities, including paid time off for philanthropic endeavors
At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.
Requirements:What You’ll Bring to the Team:
- 2+ years of experience in healthcare claims processing or resolution analyst role.
- Experienced in HCPCS, CPT, ICD10 coding.
- Knowledgeable in Medicare, Medicaid, self-funded, or commercial insurance and payment and pricing methods for Medical, Dental, and Vision claims.
- Ability to maintain strict confidentiality and handle sensitive information with discretion.
- Experience in a deadline driven environment with a knack for organization and detail.
- Ability to use MS Excel in everyday duties.
A plus if you have:
- Coding certification
