OPEN POSITIONS
LTSS Claims Consultant
REQUIREMENTS
Location: Indianapolis, Indiana – this position is a hybrid position but needs to be located in central Indiana to be onsite with partners as needed.
Summit Managed Solutions partners with healthcare organizations to help them solve their most complex problems. Our team is a diverse mix of experienced problem solvers who work with partners to create innovative solutions with enduring value.
This position will proactively support finding, fixing, and tracking claim payment issues within the Indiana Pathways program. Indiana Pathways is a managed Medicaid program for Long Term Services and Support (LTSS) for elderly Hoosiers.
What You'll Do:
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Provide expertise and support by reviewing, researching, investigating and auditing problematic claims adjudication and billing issues for Indiana LTSS claims.
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Reviews claims for data for accuracy.
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Understands, interprets, and applies business policies and procedures related to claims, auditing, and data entry.
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Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance.
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Maintains current knowledge of CMS and HIPAA regulations.
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Complies with deadlines to ensure audit cycles are completed and reported timely.
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Demonstrate working knowledge of how to utilize and navigate applicable claims processing system used internal database.
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Identify and interpret applicable provider contract information.
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Serve on applicable cross-organizational quality committees/work groups to identify/ communicate common claims quality issues, trends, and patterns.
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Perform queries on relevant claims systems in order to obtain relevant information for audits.
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Validate claims data against information from claims processing systems to ensure that data is accurate.
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Analyze claims data against applicable policies and regulations to identify potential issues (e.g., member benefits, provider contracts, billing anomalies, payment accuracy, claims processing system issues, state mandates).
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Review history of related claims to pull in and understand additional claims-related information.
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Calculate dollar amount of financial claim errors/defects.
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Responsible for all aspects of quality assurance.
What You'll Need:
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5+ years of experience in healthcare billing and/or claims operation for LTSS products. Desired claims expertise in one or more of the following areas: Nursing facilities, home community based services, hospice.
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Must be proficient with Microsoft Excel (pivot tables).
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Comfortable using computer systems, databases, and software applications for data entry and reporting purposes.
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A bachelor's degree or related work experience in healthcare preferred
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Ability to create claims audit programs and improvement initiatives to advance the goals of the partner strategy.
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Detail-oriented and capable of managing multiple tasks efficiently while ensuring accuracy and meeting deadlines.
What we offer:
We offer a competitive salary and benefits package, including unlimited PTO to encourage a healthy work-life balance, a company-funded Personal Giving Account for philanthropy at your discretion, and opportunities for professional development and growth.
If you are passionate about making a positive impact in healthcare, we encourage you to apply and become part of our dedicated team.
WHAT WE OFFER
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Competitive salary plus bonus plan
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Medical, dental & vision Insurance with employer HSA contribution
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Company paid STD/LTD and Life Insurance
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Unlimited PTO plan to encourage a healthy work - life balance
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Paid company holidays
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401k with company contribution
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Company funded Personal Giving Account for philanthropy at your discretion
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Monthly technology stipend to help cover additional working expenses
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A fun, collaborative, entrepreneurial environment with support from empathetic leaders
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The opportunity to create, build and grow innovative solutions with world class partners
WHAT WE VALUE
WE TAKE INITIATIVE
We have a bias for action. We make decisions with imperfect information and quickly move forward. We are comfortable with discomfort. We learn, we iterate, and we progress.
WE IMPACT
We have exceptionally high standards and strive to add value through all interactions. We seek, uncover, and speak truth. We measure our success in terms of what we build for partners.
WE INNOVATE
We dream big and we lead through vision. We challenge the status quo and push boundaries. We’re optimists who ignite positive transformations.
ABOUT INDIANA MEDICAID
Medicaid is a health program that provides insurance and benefits for specific populations in the US. The Federal government establishes general guidelines for the administration of Medicaid benefits. Individual states are charged with administering Medicaid so eligibility requirements and the type and scope of services provided can vary by state.
In Indiana, there are 4 main Medicaid programs: Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW), Hoosier Care Connect (HCC), and PathWays. HIP covers Indiana residents ages 19 to 64 who meet specific income levels. HHW covers children up to age 19 and pregnant women. HCC covers individuals who are aged 65 years and older, blind, or disabled and who are also not eligible for Medicare. PathWays will launch in 2024 and covers Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits.
The state of Indiana contracts the administration of its Medicaid programs (a term known as Managed Care) to insurance companies like Elevance Health (formerly known as Anthem), Humana, CareSource, MDwise, UnitedHealthcare, and others. These insurance companies are responsible for ensuring the care of their members and do way more than just process claims and provide a network of doctors and hospitals. These companies also ensure members have reliable transportation to appointments, have access to healthy food, educate youth on the importance of annual physicals, provide nurse case managers to members with chronic illnesses, provide member resources for stable housing, convene events and celebrations in communities, collaborate with professional sports teams to raise awareness of health issues, coordinate in-home care, deliver dental hygiene kits to churches, implement telemedicine solutions to help those living in rural areas, guide first-time-mothers through their pregnancy journey, and the list goes on!
EQUAL OPPORTUNITY EMPLOYER
Summit Managed Solutions is an equal opportunity employer, and we value diversity at our company. We do not just accept diverse backgrounds, we celebrate them. Our company, the work we do, and our partners benefit from the value of a diverse team. No team member's value lies alone in their diversity, and because we value diversity so highly, we reiterate that all hiring and employment decisions are made on merit, performance, competence, and business needs. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.