Analyst, Claims Customer Service (Remote)

Tango is a leader in the home health management industry, preparing for significant growth. The Claims Customer Service Analyst is responsible for managing and resolving claims-related inquiries and escalations with a strong focus on accuracy, compliance, and provider satisfaction.

Responsibilities:

• Serves as the first point of contact for providers with questions about claims and the breakdown of payments
• Oversee adverse claims escalations/disputes/reconsiderations process
• Answers escalated provider tickets/calls and escalations in collaboration with the Network team per team standards
• Analyzes/Strategizes long term solutions for applicable claim inaccuracies identified and alerts Claims Leadership/Networks as applicable
• Reprocess and re-export of claims; resolve medical billing discrepancies in accordance with tango’s Provider Manual
• Interpret and apply HIPAA guidelines, contracts, and fee schedules; educate internal staff and providers as needed
• Utilize coding/authorization knowledge (CPT, HCPCS, HIPPS) to assess dispute validity and support claim adjudication
• Handle inbound and outbound calls with providers, offering resolution and guidance
• Educate providers verbally and electronically on EDI transmission errors and clean claims submission practices
• Manage and respond to claims documentation requests in a timely manner
• Monitors/Maintains Plexis Alerts (process of EOP distribution) after each claim run
• Collaborate with Networks on high-volume denial/rejection claims, developing plans for improved submission
• Participate in monthly Claims Webinars and provider training sessions
• Ability to consistently meet productivity and quality standards
• Review escalated ticket/inbound and outbound call inventory and audit findings (external and internal) to maintain compliance with company policies
• Manage escalated claims issues and provider concerns promptly and professionally
• Working in Power BI, PCM, Tempo, Freshdesk and Elevate

Requirements:

• 3-5 years minimum experience in Medical Billing and Coding claims processing
• 1-3 years of experience in a healthcare call center, health insurance, medical office or claim processing environment
• Strong knowledge of claims processes, benefits and billing procedures
• Proficient with call center software (e.g., Avaya, Elevate, Cisco) and CRM systems
• Strong knowledge of HIPPS, CPT, and HCPCS coding systems
• Familiarity with eligibility, authorization and claims submission standards across multiple lines of business
• Experience supporting system testing, enhancements, and data portals
• Advanced proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Strong interpersonal, written, and verbal communication skills
• Proven self-starter, analytical, research, problem-solving, and decision-making skills
• Leadership and coaching capabilities
• Ability to prioritize, organize, and meet deadlines in a fast-paced environment
• Ability to multitask in a fast-paced environment
• Professional-level training or certification in claims processing, healthcare administration, or related fields preferred