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Claims Review Analyst
Job in
New York, New York County, New York, 10261, USA
Listed on 2026-09-26
Listing for:
EmblemHealth
Per diem
position Listed on 2026-09-26
Job specializations:
-
Healthcare
Medical Billing and Coding, Healthcare Administration, Healthcare Compliance, Health Informatics
Job Description & How to Apply Below
- Support contract performance management of a large health system.
- Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines.
- Identify and analyze single issues and trends to determine root causes.
- Provide recommendations for solutions to minimize errors and delays in systems and/or processes.
- Monitor system output to ensure proper functioning.
- Support contract performance management of a large health system.
- Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines.
- Identify and analyze single issues and trends to determine root causes.
- Provide recommendations for solutions to minimize errors and delays in systems and/or processes.
- Monitor system output to ensure proper functioning.
- Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review.
- Maintain and organize detailed information on claims dispute files to ensure appropriate and comprehensive data is returned to the provider timely.
- Track issues and monitor trends to support their resolution.
- Identify potential/actual claims problems (single or recurring/trending) and document root cause analysis; present findings to management.
- Improve quality, enhance workflow, and provide efficiencies within departments, identify opportunities for improvements; develop and present recommendations for changes.
- Conduct regular meetings with the assigned provider groups for status of AR files and recycles
- Support departmental goals for cycle time by organizing and tracking claims for review.
- Monitor and provide timely responses for the designated provider group emails and AR files.
- Perform other related tasks as directed or required.
Education, Training, Licenses, Certifications
- Bachelor’s degree required; additional experience/specialized training may be considered in lieu of education requirements
- 2 – 3 years’ prior related work experience in professional/facility claims or benefits/billing environment required
- Strong knowledge of claim processing policies and procedures required
- Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures required
- Proficiency with MS Office applications (word processing, database/spreadsheet, presentation) required
- Ability to accurately interpret information from contractual and technical perspectives required
- Must be conscientious and detail oriented; ability to recognize unusual patterns and troubleshoot for operational improvement and efficiencies required
- Strong analytical and problem-solving skills required
- Ability to effectively work on multiple projects/tasks with competing priority levels and deadlines required
- Ability to effectively absorb and communicate information required
- Strong Interpersonal and teamwork skills required
- Requisition :
- Hiring Range: $48,600-$83,160
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