Company Overview

Boon-Chapman is not your average Third Party Administrator. In addition to traditional TPA services, Boon-Chapman administers business process outsourcing for insurance entities, and other services through its sister companies. With nearly 55 years in business, Boon-Chapman combines the legacy of a family-owned-and-operated company, with the energy and potential of a fast-growing enterprise of companies. A few of our benefits include:

• Paid holidays & competitive PTO that increases with tenure
• Full benefits package including healthcare, dental, 401(k), vision, paid STD & life
• Casual everyday dress
• Work from home opportunities
• Unlimited opportunities for growth – success is in your own hands!

Job Overview

As a Cost Containment Analyst you’ll be serve as support to the Claims team by handling transplant cases (including benefit verification, & claims processing), the Dialysis Program and specialized dialysis pricing, as well as complex claim calculations. Cost Containment also handles appeals, claims adjustments/refunds, Medicare pricing, processing of fees, refund recovery, claim edit verification, OON negotiations, subrogation, Cost Comparison Program, and bill reviews for the medical department. Key responsibilities include:

• Reviews and researches appeals / disputes and provides a written response in a timely manner.
• Calculates adjustment payments of benefits in accordance with coverage information, contract language or plan document, and medical documentation.
• Calculates overpayments and requests refunds of benefits in accordance with coverage information, contract language, or plan document and medical documentation.
• Posts refunds of overpayments in the system and provides a written response to the client or provider.
• Calculates pricing affected by partially denied services.
• Recognizes all parts of a UB04 and HCFA1500 to accurately price to Medicare.
• Reviews transplant contracts and processes related transplant claims according to the transplant program.
• Processes variety of fees, including but not limited to: negotiations, savings, IRO, & PBM.
• Determines and documents primary / secondary status of members who are eligible under the Dialysis Program.
• Communicates clearly with clients, participants, brokers, vendors, and others within the department and company regarding any of their assigned duties.
• Meets monthly quality standards and production goals.

• High school diploma or equivalent.
• 2+ years of claims processing experience.
• Knowledge of CPT, HCPCS, ICD9, ICD10 coding.
• Knowledge of claims processing.
• Knowledge of Eldorado system preferred.
• Knowledge of professional customer service practices.
• Skill in interpersonal and written communication.
• Ability to work independently.
• Ability to solve problems and analyze information.
• Ability to adapt to a constantly changing environment.
• Ability to multi-task.
• Ability to accurately compile data and perform detailed work.
• Ability to meet deadlines.
• Ability to maintain regular attendance.
• Ability to maintain confidentiality of material and information.
• Ability to maintain professional appearance and demeanor.
• Ability to work as a member of a team.