Claims Analyst

Claims Analyst

Claims Analyst analyzes and reviews insurance claims for accuracy and completeness to be submitted to the payer. Also maintains open communication with various departments within the facility.

SUPERVISION: Reports directly to the Reimbursement Analyst

• Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.
• Documents all information in the System following the Clear Concise Consistent method.
• Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.
• Properly utilizes productivity tracking mechanisms.
• Works at or above the weekly set productivity standard and completes tasks in a timely manner.
• Accurately analyzes, corrects and releases assigned claims daily.
• Follows the appropriate process for notification to the responsible area.
• Works with other departments to resolve any outstanding billing deficiencies.
• Consistently analyzes and communicates with leadership and responsible areas on held claims to ensure that all claims are released timely.
• Maintains assigned task by ensuring that the task is completed timely.
• Ability to evaluate a difficult billing problem and find the resolution.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

• High school graduate or GED certificate.
• Prefer at least one year experience in Healthcare or related field.
• Adequate keyboarding and basic computer skills.
• Strong organizational and communication skills.
• Assertiveness with positive attitude and being proactive.

• Must be able to remain in a stationary position at least 50% of the time.
• Constantly operates a computer and other office machinery such as a calculator, copy machine, fax machine and computer printer.
• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.