Healthcare Claims Analyst

ROLE SUMMARY

Our client is looking for a Healthcare Claims Analyst who will be responsible for accurately and efficiently reviewing contracts, researching healthcare provider claims, thoroughly documenting investigation results, and identifying and implementing appropriate and effective resolution strategies.

This role will handle the review and assessment of clinical denials, including review of patient medical information, patient account documents, patient account history, company historical data, provider contracts, and regulations as appropriate. He/she will draft focused, successful appeals, meet, and confer documents, IRO submissions, and when necessary, assist with legal submissions on clinical issues.

SCHEDULE: 9:00 AM – 6:00 PM Pacific Daylight Time (12:00 AM – 9:00 AM Philippine Standard Time), follows Philippine holidays

POSITION TYPE: Full Time

WORK ARRANGEMENT: Remote

ESSENTIAL FUNCTIONS

·       Prioritize voluminous claim review workload

·       Validate claim status, claim liability, and availability of coverage

·       Understand concepts of coverage, insurance contract interpretation, and reimbursement methodologies

·       Process pricing claims

·       Review and validate coding

·       Research and analyze information gathered through investigation to identify reimbursement issues, develop solutions, and initiate appropriate claim resolution strategies

·       Maintain quality and productivity standards as set by the management

·       Influence others using a positive approach

·       Work independently with minimal supervision

·       Perform special projects as requested or as assigned by the pre-litigation services manager

·       Ensure compliance with the Health Insurance Portability and Accountability Act

QUALIFICATIONS

·       A bachelor’s degree in the related field is preferred

·       3-5 years of position-specific related work experience (managed care, revenue cycle, data mining, and/or legal)

·       3-5 years experience working on hospital claims

·       Experience with Microsoft Office products

·       Experience with healthcare provider claims management software is highly preferred

·       Government payor experience is also preferred

·       Strong analytical, problem-solving, and research skills

·       Excellent verbal and written communication skills

·       Highly detail-oriented with strong organizational skills

·       A team player with a curious personality

·       Ability to multitask and thrive in a fast-paced work environment