SUMMARY: The Claims Analyst is responsible for analyzing a percentage of processed claims for accuracy according to the provider contract and company policies and procedures by performing the following and other duties that may be assigned.
ESSENTIAL FUNCTIONS
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Conduct audits and reviews of claims. Document the findings and recommendations.
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Request all information from internal or outside sources to ascertain completeness and validity of claims.
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Analyze claim trends to determine any necessary refinement of business rules and workflows in order to improve the overall claims process.
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Contribute to the development of claims analysis reports.
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Research claims as needed.
REQUIRED SKILLS AND ABILITIES
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Displays written and verbal communication skills with administration and external parties.
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Able to work collaboratively, diplomatically, maintain confidentiality, and with integrity in problem identification and problem solving activities.
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Displays knowledge of ethical principles and compliance issues in an accounting setting.
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Knowledge of claims processing.
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Possesses good organizational skill, ability to focus on assigned tasks.
QUALIFICATION
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High School Graduate or equivalent. Some college preferred.
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Minimum 2 years of relevant claims processing experience, preferably in a health care environment or a minimum of six months of internal claims processing experience.
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Strong written and verbal communication skills.
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Basic working knowledge of excel and Microsoft office.
