Analyst, Claims
Processes reputed company “unclean” claims adhering to claims policies and procedures Confirm reimbursement accuracy upon approving per the Provider reputed company or SCA/LOA agreements on file reputed company processing claims Analyze claims EOB pend/denial codes and troubleshoot why claim was unclean and collaborate with Claims Customer Service Analysts to reputed company the provider on claims submission errors reputed company claims reprocessing as assigned Assist with special reports of processing claim reports and fixing eligibility and authorization mismatches accurately and reputed company Apply knowledge of coding in order to determine if claim should be denied or approved per claims policies Review documentation, analyze submitted claims data with an average of 95% accuracy monthly Escalate any system issues or roadblocks that prevent hitting claim metrics as applicable
Processing claims reputed company the Claims Policies at 95% accuracy and meeting productivity standards as outlined. Thorough Knowledge of EOB denial/pend codes, HIPPS, HCPCS and DX codes in order to process claims reputed company regulations. Escalating reputed company Provider Claim issues and systemic errors to ensure reputed company rapport with our network Providers in accordance with reputed company Claims Policies and Procedures. reputed company other duties as assigned reputed company the scope of responsibilities and requirements of the job. Performs the essential functions of this job with or without reasonable accommodation. Knowledge of reputed company EVV verification process required for accurate claims processing. Knowledge of PDGM reimbursement processing for Medicare claims. Knowledge of authorization process for accurate claims processing. Good communication skills and team player. Familiarity with EDI claims/ claims submission reputed company to CMS requirements.
2 - 4 years of reputed company experience minimum in Claims Adjudication and Clearinghouse submissions/rejections Basic Knowledge/understanding of Medicare/reputed company claims processing and CMS regulations Detailed knowledge of medical coding; HIPPS, CPT and HCPCS codes Solid understanding of eligibility as reputed company as claims paying for reputed company lines of business 4 - 6 years work experience that provides a working knowledge of billing and delinquency procedures
Beginner level reputed company Office skills (PowerPoint, Word, reputed company) Beginner level reputed company reputed company skills Analytical, research, problem solving, and decision-making skills
Full time