Description:
As a Claims Analyst, you will:
- Support the processing team with analysis of claim issues and inquiries.
- Perform root cause analysis and course correct identified issues for full resolution.
Research root cause of incorrectly processed claims.
- Provide solutions and coordinate with appropriate team members to repair the claim and provide re-education to the processor or submit ticket for system enhancement.
- Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and applications/tools.
- Share this knowledge and skill with other team members to instill across the team the opportunities that they can escalate to process improve. Schedule reoccurring meetings to keep momentum.
- Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.
- Assist with pulling the data needed and assist with the documentation of processes and work procedures.
- Represent Department as SME in meetings, projects and company initiatives
- Advanced skills in Microsoft Office and with Microsoft platforms (e.g. Excel, Word, PowerPoint) is required
- Experience with technologies, desktop tools and or Operations processes and technology is helpful
Perform other duties as assigned
The ideal candidate will have:
- Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration.
- Experience working with health systems in the billing revenue space working with health system provider data, and medical claims administration.
- Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
- Working experience with SQL and Access is required.
- Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), claims processing software. Ability to summarize large amounts of data and pivot data in multiple ways
- Analytical Skills: Ability to assess claim data in detail and identify errors or inefficiencies. Possess excellent mathematical skills and can work independently and within tight timeframes.
- Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly