Hospital Claims Analyst

Bottom Line Systems - Bowling Green, KY (30+ days ago)3.8

Position Summary: Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client.

Essential Duties and Responsibilities:

  • Build strong, lasting relationships with clients, payors and BLS personnel
  • Review insurance contracts to gain thorough understanding of payment methodologies
  • Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
  • Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
  • Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting
  • Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other BLS personnel
  • Support and direct claims to all BLS departments and client onsite analysts
  • Attend client, department and company meetings
  • Comply with federal and state laws, company and department policies and procedures

Essential Skills and Experience:

  • Minimum 2-years experience working in an operational setting, preferably managed care or hospital patient accounts
  • High School diploma or equivalent
  • Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
  • Experience working with ICD-9, CPT-4 and/or HCPCS coding systems
  • Knowledge of insurance submittal procedures and medial forms (including UB04 and CMS1500)
  • Experience performing account resolution with third party payors
  • Accounts receivable collections from payors (no self pay)
  • Ability to effectively identify and communicate payor trends
  • Organization and documentation skills to ensure timely follow-up and accurate record keeping
  • Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
  • Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
  • Ability to present written routine correspondence (in English)
  • Ability to present ideas on complex, detailed issues with ease
  • Ability to define problems, collect data, establish facts and draw valid conclusions
  • Strong customer service orientation
  • Excellent interpersonal and communication skills
  • Strong team player
  • Commitment to company values

Non-Essential Skills and Experience:

  • Related Professional License/Certification(s)
  • Associate or Bachelor's Degree(s)

Job Type: Full-time