Claims Analyst - Alternate Funding Program

Position Type:
Permanent

If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place.

As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.

Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it's reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.

The Claims Analyst - Alternate Funding Program is responsible for a wide variety of claim types under the Alternate Funding Program within Medicare. Each claim type has a varying degree of eligibility and policy requirements. The Claims Analyst will analyze, investigate, and pay medical claims which include the payment of locum, sessional, psychiatry and various other claims. Additionally, they are required to maintain current knowledge with respect to policy and procedure changes. The successful candidate will work with the leadership team and colleagues to help ensure exceptional customer service is provided to the Nova Scotia Department of Health and Wellness, and our provider and resident stakeholders.

Key Responsibilities:

• Review, analyze and set up payment data based on contracts forwarded from the Department of Health & Wellness.
• Maintain and reconcile contract payments to physicians using standard procedures.
• Adjudicate and apply data entry functions for all alternate funding programs and billings from physicians with a strong emphasis on accuracy and efficiency.
• Liaise with Physicians, support staff and various stakeholders in a professional manner with respect to system use, claims submissions, and payment reconciliations.
• Review applications from the Boarding, Transportation and Ostomy Program as well as the Locum Program to determine eligibility
• Support the update and development of business area procedures. This will include developing proper training material and support systems for business area
• Perform quality assurance checks on claims adjudication to ensure payment accuracy and consistency among staff.
• Support Escalations for claims adjudication in a calm manner with a sense of urgency. Liaise with internal and external partners to support resolution of concerns and to maintain effective working relationships.

Required Qualifications:

Education: Post-secondary education in Business Administration, Accounting, Finance or other related field, a combination of education and experience may be considered.

Work Experience: 3+ years of relevant experience would be an asset.

Other Qualifications: Able to adapt in a changing and fast paced environment with the ability to accept and implement changes; able to work independently. Possess a high attention to detail and a high level of accuracy; analytical in nature and have proven problem solving skills with an aptitude for mathematics.

Core Competencies:

Computer Skills: Experience working in a PC setting with multiple software applications (i.e., MS Office Suite: Excel, Word, Power Point ) including experience navigating between application and the internet. Strong keyboarding skills and the ability to enter data with speed and precision, accuracy and attention to detail.

Communication Skills: Excellent communication skills by way of verbal, written, and electronic medium. Listens to directions and instruction with the ability to accurately restate them to ensure full understanding.

Execution and Organization: High level of accuracy with attention to details while maintaining the ability to complete assigned tasks and meet deadlines. Ability to set and work through list of priorities in a timely manner.

Analytical Thinking: Develop the business knowledge and experience required to solve routine problems. Ask questions to determine the source of the problem. Discuss possible solutions and make suggestions.

Teamwork: Demonstrates a willingness to learn, while working collaboratively to achieve common goals by asking for feedback, sharing information and encouraging others to share information.

Language Skills: Bilingualism is considered an asset.

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We believe our employees should reflect the communities we serve and welcome applications from candidates of all backgrounds. To provide the best experience possible, we will support you with accommodations or adjustments at any stage of the recruitment process. Simply inform our Recruitment team of your needs. We are committed to making sure recruitment, retention, advancement, and compensation are fair and accessible while following all relevant human rights and privacy laws . We appreciate everyone who has shown interest in this position. Only those selected for an interview will be contacted.

If you experience any technical issues throughout the application process, please email: [email protected] .