Claims Analyst

Mar 20, 2017

Position Summary Performs those duties necessary to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines. Essential Job Functions Conducts timely follow up of claims as needed. Informs department manager of Emdeon issues in a timely manner. Integrates compliance standards and payer specific data to properly file claims. Attends mandatory training sessions as directed by the Corporate Compliance Officer and the Billing Compliance Officer as recorded in the education logs. Maintains and updates appropriate system documentation to provide information regarding claim processing to internal or external customers. Participates in Emdeon training sessions as required. Completes reminders received per department guidelines. A — Follows the guidelines created to maintain resolution to account issues in a timely manner. Identifies patterns of claim submission issues that might require Compliance and Charge master staff to resolve. Identifies patterns of claim submission issues that might require HIPAA transaction code set review. Informs staff of status of issues. A — Uses tools provided to trend and track patterns related to monthly submission of claims. Demonstrates ability to explain issues to leadership. E — Addresses situations from trend and tracking patterns. Research payor requirements and offer suggestions to leadership. Communicates verbally in a clear, concise manner. Provides clear guidelines and directions when communicating to others. Responsible for accurate, timely filing of claims in accordance with established guidelines and compliance regulations. Responsible for personal organization of activities and adherence to personnel policies and procedures. Education/Experience Requirements High School diploma/GED Required Preferred BS/BA Business or Accounting Degree from an accredited College or University 3 years General Clerical experience or 1 year Healthcare/Medical experience preferred