<p>Location: Minneapolis, MN</p><br/><p>Employment Type: Full Time</p><br/><p>Team: Health Plan Administration</p><br/><div><span style="font-size: 16px">&nbsp;</span></div><div><span style="font-size: 16px">Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative,&nbsp;consumer-centric health benefit solutions that people can actually use.&nbsp;Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><span style="font-size: 16px">As Gravie looks to continue its member-centric approach to healthcare, the </span><b style="font-size: 16px">Senior Medical Claims Examiner </b><span style="font-size: 16px">will support, review and adjudicate claims in our best in class claim system. The Senior Medical Claims Examiner will be a subject matter expert capable of thoroughly evaluating, researching, and analyzing claim submissions with a solid knowledge of national claims guidelines. In addition to personally reviewing complex claims, the Senior Medical Claims Examiner will play a key role in elevating the performance of the team, assisting in training, serving as a resource to other Examiners, and pitching in as needed with special projects. The Senior Medical Claims Examiner will also support leadership with inventory management, process development, auditing, and other tasks as assigned.</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><b style="font-size: 16px">You will:</b></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Support team discussions, aid in team claims issue resolution efficiently, and lead by example.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accurately review, investigate and confirm coverage to appropriately process medical claims and identify key components of processing requirements based on contracts, policies and procedures</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Support team in testing claims and system configurations.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Play a key role in helping develop team members to perform at their highest level by offering coaching opportunities, sharing expertise and best practices, offering on the spot feedback and celebrating achievements.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Examine and confirm coverage to appropriately process medical claims and identify key components of processing requirements based on contracts, policies and procedures.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Review claims queues and provide expertise to address nuances with appropriate parties.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Assist with periodic claims and process auditing to improve department outcomes.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Continually meet department metrics and quality&nbsp;set forth by leadership&nbsp;</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Play a key role in the development of departmental workflows and procedures.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Facilitate the department specific training and continuation of education training.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Collaborate with QA team to determine necessary updates to department processes and procedures to improve departmental quality and efficiency</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Work with leadership to monitor and report on KPI data</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Communicate complex claims issues clearly through documentation and direct communications</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ability to utilize multiple applications to fulfill all job functions</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><b style="font-size: 16px">You bring:&nbsp;</b></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; High School Diploma</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 5 + years of experience processing/adjusting and/or analyzing medical claims preferably in a TPA environment&nbsp;</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Strong knowledge of CPT/HCPC and ICD-10 code rules</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Previous experience using Javelina processing system</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ability to set priorities, manage time and work independently</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Basic proficiency using Windows based other computer applications</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional comfort with Zoom, Microsoft Teams, or Google Meets</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; General knowledge of CMS claims submission regulations</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Demonstrated success getting results through collaboration</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Excellent facilitation and transferable knowledge skills communicating effectively on complex concepts</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Proven ability to develop and implement medical claims processes</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Experience in managing and assigning claims inventory</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><b style="font-size: 16px">Extra credit:&nbsp;</b></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Medical Coding experience/certification</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Medical Billing experience</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Understanding of provider data</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Previous start-up company experience</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Degree in Healthcare Administration or similar field</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Training and ability to create processes/procedure documentation is a plus</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><span style="font-size: 16px">Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.</span></div><div><span style="font-size: 16px">&nbsp;</span></div>

Location: Minneapolis, MN

  

Employment Type: Full Time

  

Team: Health Plan Administration

  



Hi, we’re Gravie. Our mission is to improve the way people purchase and access
healthcare through innovative, consumer-centric health benefit solutions that
people can actually use. Our industry-changing products and services are
developed and delivered by a diverse group of unique people. We encourage you
to be your authentic self - we like you that way.



As Gravie looks to continue its member-centric approach to healthcare, the
**Senior Medical Claims Examiner** will support, review and adjudicate claims
in our best in class claim system. The Senior Medical Claims Examiner will be
a subject matter expert capable of thoroughly evaluating, researching, and
analyzing claim submissions with a solid knowledge of national claims
guidelines. In addition to personally reviewing complex claims, the Senior
Medical Claims Examiner will play a key role in elevating the performance of
the team, assisting in training, serving as a resource to other Examiners, and
pitching in as needed with special projects. The Senior Medical Claims
Examiner will also support leadership with inventory management, process
development, auditing, and other tasks as assigned.



 **You will:**

·       Support team discussions, aid in team claims issue resolution
efficiently, and lead by example.

·       Accurately review, investigate and confirm coverage to appropriately
process medical claims and identify key components of processing requirements
based on contracts, policies and procedures

·       Support team in testing claims and system configurations.

·       Play a key role in helping develop team members to perform at their
highest level by offering coaching opportunities, sharing expertise and best
practices, offering on the spot feedback and celebrating achievements.

·       Examine and confirm coverage to appropriately process medical claims
and identify key components of processing requirements based on contracts,
policies and procedures.

·       Review claims queues and provide expertise to address nuances with
appropriate parties.

·       Assist with periodic claims and process auditing to improve department
outcomes.

·       Continually meet department metrics and quality set forth by
leadership

·       Play a key role in the development of departmental workflows and
procedures.

·       Facilitate the department specific training and continuation of
education training.

·       Collaborate with QA team to determine necessary updates to department
processes and procedures to improve departmental quality and efficiency

·       Work with leadership to monitor and report on KPI data

·       Communicate complex claims issues clearly through documentation and
direct communications

·       Ability to utilize multiple applications to fulfill all job functions



 **You bring:  **

·       High School Diploma

·       5 + years of experience processing/adjusting and/or analyzing medical
claims preferably in a TPA environment

·       Strong knowledge of CPT/HCPC and ICD-10 code rules

·       Previous experience using Javelina processing system

·       Ability to set priorities, manage time and work independently

·       Basic proficiency using Windows based other computer applications

·       Functional comfort with Zoom, Microsoft Teams, or Google Meets

·       General knowledge of CMS claims submission regulations

·       Demonstrated success getting results through collaboration

·       Excellent facilitation and transferable knowledge skills communicating
effectively on complex concepts

·       Proven ability to develop and implement medical claims processes

·       Experience in managing and assigning claims inventory



 **Extra credit:  **

·       Medical Coding experience/certification

·       Medical Billing experience

·       Understanding of provider data

·       Previous start-up company experience

·       Degree in Healthcare Administration or similar field

·       Training and ability to create processes/procedure documentation is a
plus



Competitive pay is standard. Our unique benefits program is the gravy, i.e.,
the special sauce that sets our compensation package apart. In addition to
standard benefits, Gravie’s package includes alternative medicine coverage,
flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone
reimbursement, education reimbursement, and 1 week of paid paw-ternity leave
just to name a few.



