Workers Comp / MVA Claims Resolution Analyst

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians.

Position Summary :

We are seeking a skilled Workers Comp / MVA Claims Resolution Analyst with expertise in Workers' Compensation and Motor Vehicle Accident (MVA) claims to join our team in Dallas, TX. This role is responsible for reviewing, analyzing, and resolving hospital claim denials related to workplace injuries and motor vehicle accidents. The ideal candidate will have strong knowledge of payer guidelines, medical billing, and appeals processes, with the ability to secure appropriate reimbursement for services rendered.

Key Responsibilities :

• Review and analyze denied hospital claims for Workers' Compensation and MVA cases to determine root causes and resolution strategies.
• Prepare and submit appeals, reconsiderations, and supporting documentation to insurance carriers, third-party administrators, and attorneys.
• Collaborate with hospital billing, coding, and clinical teams to ensure accurate claim submission and compliance with payer requirements.
• Maintain detailed claim activity notes and track status through resolution.
• Research and interpret state and federal regulations, including Texas Workers' Compensation rules, to strengthen appeals and ensure compliance.
• Work with payers and adjusters to negotiate payment or overturn denials.
• Identify trends in denials and recommend process improvements to reduce future rejections.
• Monitor accounts receivable (A / R) for aging claims and prioritize high-dollar or high-impact cases.
• Communicate effectively with patients, providers, and internal stakeholders regarding claim status and resolution.

Qualifications :

Seniority level : Mid-Senior level

Employment type : Full-time

Job function : Accounting / Auditing, Analyst, and Finance

Industries : Hospitals and Health Care

Prime Healthcare offers a competitive benefits package, including medical insurance, vision insurance, and 401(k).

J-18808-Ljbffr