Medical Claims Quality Analyst

The Medical Claims Quality Analyst role is to analyze all medical orders for potential discrepancies before forwarding to the appropriate insurance parties

Duties and Responsibilities

• Reviews individual claims and orders to identify errors and inaccuracies to assure insurance payment reimbursement;
• Understand various insurance companies’ guidelines, policies, procedures and fee schedules;
• Analyze provider issues and collaborate with other departments to resolve;
• Maintain records, files, and documentation as appropriate;
• Participates in accounts receivable projects;
• Participates in standing meetings as necessary;
• Performs other duties and special projects as assigned and directed;

Basic Qualifications

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• High School diploma or equivalent required; college preferred

Required Skills

• Effective and professional verbal and written communication abilities
• Great customer service skills
• Professional computer experience (especially Microsoft Office Suite)
• Ability to work independently to investigate and make decisions
• Strong attention to detail
• Ability to prioritize and complete work amidst interruptions in a busy work area
• Available during normal hours of operation
• Ability to comply with guidelines both internal and industry-imposed
• Bilingual in English and Spanish preferred

Competencies

• Computer Skills
• Customer Service
• Ethics
• Organization Skills
• Productivity
• Results Driven

Work Environment & Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
• This role routinely uses standard office equipment such as computers, phones, and printers/scanners

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This job operates in a professional office environment
• The noise level in the work environment is usually moderate to loud

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.