Claims Analyst

Location: Doral, Florida
Posted On: 5/3/2017
Job Code: 3454_CA_FL
Job Description
This department handles claim provider complaints.
Review of claims that have already been processed by the system.
The suppliers are complaining about issues with the previously processed claims.
Will be identifying root causes, necessary correction of root causes and provide feedback to providers.
Will be utilizing MS Excel heavily.
A minimum of 1-2 years experience in claims processing with professionals or hospitals.

Top 3 skills:
Computer skills - MS Excel (intermediate to advanced skills, ie: pivot tables, v-look ups)
Attention to detail
Strong written communication skills

Must Haves:
Claims background
Knowledge of billing guidelines
Knowledge of contract interpretation
Knowledge of billing/coding - CPT & ICD-10

Conducts analysis around various claims payment processes to ensure accuracy of system configuration and provider payments.
Investigates problem claims to determine root cause of problem and/or error to address both individual claim resolution and improvement to process to avoid issues from occurring in the future.
Perform and execute various claims process testing requests to ensure desired results are met to support accurate claims payments.

Testing categories include but are not limited to the following:
Benefit, Contract, and Fee Schedule Configuration
System Enhancements
Report Validation

Validation of electronic file loads Essential Functions:
Performs claims systems testing and/or system analysis to ensure accuracy of the systems configuration and provider payments.
Conducts research and root cause analysis on various claims issues to identify and resolve problem payment and configuration concerns.
Develops/creates test plans/scripts which to provide concise analysis and documented results of the testing outcomes based on configuration changes/updates to support new businesses, benefits, and contracts. Applies knowledge of claims processing to provide feedback resulting in the improvement of claims processing by identifying configuration improvements and/or when manual interventions and workarounds are required for configuration/system limitations.
Complies with performance standards by completing assignments within the specified time.

Excellent verbal and written communication skills
Ability to abide by policies
Maintain regular attendance based on agreed-upon schedule
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education:
High School graduate (or GED) / AA preferred

Required Experience:
2+ years of claims processing with advancement to auditing / claims analysis / claims research.
Level of autonomy/decision making required
Mid-level decision making.
Some project management skills.
Good oral and written communication skills.
Advanced Word and Excel skills.
Category:Non-IT  code:new
Job Requirements
Management,MS Word,Project Management,Research,Training

Not Ready to Apply?
Contact Details
Gomit Bisht
E-mail Address