Claims Analyst I

Job Description

Job Description

JOB TITLE : Claims Analyst

SUMMARY :

This position is responsible for assisting with following up on administrative appeals and documentation submitted to health insurers and governmental payers; working well with attorneys and paralegals; maintaining the workload.

DUTIES AND RESPONSIBILITIES :

• Works within the client’s Patient Accounting system, payer portals and / or websites, and will utilize proprietary software to research accounts in the work queue.
• Determines action required to resolve the underpayment and initiate that action, including submitting appeals and reconsideration requests.
• Utilizes increased knowledge of the industry, hospital revenue cycle, and payers / insurance companies to document the account and provide information and details to support paralegal’s / attorney’s pursuit for additional reimbursement
• Quickly and efficiently prepares, reviews, and submits well-written claims correspondence and related documents to insurers
• Is skilled, aggressive, cordial, and professional on the telephone to follow up on submitted appeals.
• Performs other related duties as assigned by management.

QUALIFICATIONS :

BA / BS with a GPA of 3.0 or higher.

COMPETENCIES :