We are seeking a talented Claims Analyst to join our team. You will be detail-oriented and analytical to help us manage and process healthcare claims efficiently. You will be analyzing, processing, and resolving healthcare claims in accordance with company policies and regulatory requirements. You will have a strong understanding of healthcare claim processing, excellent analytical skills, and the ability to work independently to ensure timely and accurate claim adjudication.
How you will make an impact
Review and analyze healthcare claims for accuracy, completeness, and eligibility
Ensure claims are processed in accordance with company policies, procedures, provider contracts and regulatory requirements
Verify patient and provider information and validate claim codes (ICD, CPT, HCPCS)
Identify discrepancies and inconsistencies in claims and take appropriate corrective actions
Communicate with healthcare providers, patients, and insurance companies to resolve claim issues
Investigate and resolve denied or rejected claims
Accurately enter claim information into the claims management system
Maintain detailed and organized records of claims and related correspondence
Prepare and generate reports on claim status, trends, and performance metrics
Stay updated on industry regulations and guidelines related to healthcare claims processing
Ensure compliance with HIPAA and other regulatory standards
Participate in quality assurance reviews to identify areas for improvement and implement best practices
Work closely with the Director of Provider Operations and other team members to improve claim processing workflows
Provide training and support to new team members as needed
Communicate effectively with internal and external stakeholders to facilitate smooth claims processing
What we are looking for
Minimum of 5 years of experience in healthcare claims processing or a similar role
Familiarity with medical terminology, claim coding (ICD, CPT, HCPCS), and insurance billing practices
Strong analytical and problem-solving skills
Excellent attention to detail and accuracy
Proficiency in using claims management software and Microsoft Office Suite
Effective communication and interpersonal skills
Ability to work independently and as part of a team
Seniority level
Not Applicable
Employment type
Full-time
Job function
Finance and Sales
Industries
Software Development
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