Claims Analyst

Position Title: Claims Analyst
FLSA Status: Hourly
Type of Position: Full Time
Department Name: Client Management 
Reports To: Revenue Cycle Team Lead

JOB SUMMARY

The Claims Analyst is responsible for the submission of clean and timely patient claims to commercial, Medicare and Medicaid insurance companies.

ESSENTIAL FUNCTIONS OF THE JOB

  • Review assigned reports and correct claims that are on hold or rejected. Note accounts as appropriate.
  • Review system reports to identify delinquent accounts.
  • Perform insurance verification to determine coverage and benefit eligibility of patient.
  • Follow up with insurance to identify reason for non-payment. Take the appropriate and necessary action to have the claim paid.
  • Respond promptly to inquiries, concerns and problems related to billing.
  • Maintain a positive dialogue and collaborative working environment.
  • Maintain thorough and detailed knowledge of medical fee schedules and reimbursement rules for numerous states including but not limited to Florida, Kentucky, Missouri, andNorth Carolina.
  • Exhibit an understanding of federal, state and contractual guidelines/regulations as it relates to Medicare, Medicaid, Managed Care, and Commercial Insurance companies to ensure ongoing compliance.
  • Demonstrate thorough knowledge of UB and 1500 electronic and hardcopy billing forms, formats, and filling requirements.

OTHER DUTIES AND RESPONSIBILITIES OF THE JOB

  • Exhibit an understanding of CPT, HCPCS, Revenue Codes, ICD-10 diagnosis and procedure coding guidelines.

SKILLS AND ABILITIES

  • Preferred knowledge of medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations, documentation standards, fee schedules, third party billing and documentation standards.
  • An overall knowledge of functions & activities of medical offices/hospitals, understanding of compliance, knowledge of various payment systems, skill in researching and resolving problems and issues
  • Knowledge of HIPAA rules and regulations.
  • All other duties as assigned.
  • Strong computer skills with knowledge of Microsoft Outlook, Word, Excel and practice management systems.
  • Excellent interpersonal skills and experience interacting with personnel (clinical staff and finance/management/administration).
  • Excellent written and oral communication skills.
  • Strong team player.
  • Adherence to strict confidentiality.
  • Able to plan, analyze and prioritize workload.
  • Meet deadlines and function independently.

EXPERIENCE REQUIREMENTS

  • Three (3) to Seven (7) years’ experience in medical claims submission, follow-up, and correction for multiple payors and claim types for a Federally Qualified Health Center, preferably in Florida or Kentucky.
  • Experience across multiple practice management systems, clearinghouses, and payers strongly preferred.

EDUCATION / CERTIFICATION REQUIREMENTS

  • High School Diploma or GED equivalent required.
  • Coding Certification a plus.

PHYSICAL REQUIREMENTS ESSENTIAL TO PERFORM THE DUTIES OF THE JOB

  • Frequently remains in a sitting position at a desk to perform duties.
  • Frequently communicates with co-workers, customers, and contractors/vendors in person, on the telephone, and on the computer.
  • Frequently works in a well-lit room.
  • Frequently views the computer to perform duties.
  • Frequently uses the computer with fingers and hands for documentation and communication.
  • Occasionally stoops, bends, or kneels.
  • Occasionally exposed to outside elements when traveling for business.
  • Occasionally required to push and/or pull objects.
  • Occasionally lifts and/or carries objects weighing up to twenty (20) pounds.

COMPENSATION

  • Competitive salary and incentive bonus commensurate with experience along with Fortune 500 level benefits.

To apply send your resume to careers@altruis.com.