medical claims analyst

Ardent Health Services

<div>Overview:
<div>
Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states.</div><div></div><div><b><br>
POSITION SUMMARY:</b></div><div></div><div><br>
The <b>Senior IT Systems Analyst</b> is responsible for the development, configuration, continuous improvement and support for hospital system applications, primarily <b>Epic Hospital Billing (HB) Claims</b>. The analyst will routinely perform in-depth analysis of workflows, data, and technical documents associated with the application area. The analyst will design, build, test, install and maintain solutions related to assigned applications.</div><br>
<div></div>
Responsibilities:<br>
<div></div><ul><li>
Translate best practices in Epic Revenue Cycle specifically Resolute Hospital Billing Claims and Remittance into application and workflow designs.</li><li>
Analyzes application release notes and technical specs to identify impact and opportunities; plans and executes on new functionality in upgrades.</li><li>
Evaluates current state processes and identifies gaps to future state goals related to IT application utilization.</li><li>
Provides ongoing analysis, technical and functional support for systems throughout the organization.</li><li>
Independently manages assigned project tasks to remain on track with timelines; proactively communicates risks, delays and issues.</li><li>
Demonstrates ability to communicate information to internal and external customers in a clear and concise manner and delivers difficult/sensitive information tactfully.</li><li>
Represents application area in operational meetings at corporate, service line and facility levels.</li><li>
Mentors teammates in application design and support.</li><li>
Leads testing efforts and ensures issues are identified, tracked, reported on and resolved in a timely manner.</li><li>
Participates in business continuity planning and assists with the development of disaster recovery measures.</li><li>
Participates in after-hours support On-Call rotation.</li></ul>
Qualifications:
<div><b>
Education &amp; Experience:</b></div><ul><li>
BA/BS degree or equivalent.</li><li>
4 years of experience in applicable business area (clinical, operational or IT systems support).</li><li>
Current Epic Resolute Claims and Remittance Administration certification.</li><li>
Experience in data analysis and report generation with Epic Slicer Dicer and Reporting Workbench.</li><li>
3+ years of experience working within Information Technology implementing and supporting applications, preferred.</li><li>
Experience working in a healthcare environment, Epic Resolute Hospital Billing or healthcare IT, preferred.</li><li>
Experience with regulatory reporting and regulatory requirements in applicable clinical area, preferred.</li></ul><div><b>
Knowledge, Skills &amp; Abilities:</b></div><ul><li>
Proven ability to understand business issues and objectives as well as the ability to translate them into application solutions.</li><li>
Strong understanding in the areas of application technology and system design</li><li>
Basic project management skills (ability to lead meetings, prioritize, resolve conflicts, maintain issues list, manage project plan).</li><li>
Excellent oral and written communication skills.</li></ul><div>
#LI-ET1</div><div>
#LI-BB1</div></div>

Senior IT Systems Analyst - Hospital Billing Claims

Ascribe Healthcare Solutions

<div></div><div><div><div><div><div>A Sr. medical biller is responsible for submitting &amp; resubmitting medical claims to insurance companies and payers on behalf of the hospital. The main purpose of the role is to adjudicate and process the account/claim with quality in a professional manner according to policy terms and conditions. The medical biller will hold responsibility for the account/claim until payment is done. He/ She needs to apply the clinical guideline and sound judgment of medical necessity when assessing the account. Additionally, the role will need to interpret and process claims with correct usage of standard codes (e.g. ICD, DRG, CPT, and HCPCS) applicable billing structure, policy terms, and benefits. Ensure that all medical information is kept confidential as per compliance.</div>
</div>
</div></div><div><div><div><div><div><h4 class="jobSectionHeader"><b>Roles and Responsibilities</b></h4><ul><div><p>
Reviewing patient bills for accuracy and completeness, and obtaining any missing information</p></div><div><p>
Evaluates and processes claims per insurance policy terms and conditions</p></div><div><p>
 Work per company policies and procedures</p></div><div><p>
Identify and report back any type of claims observation or issues that may affect the process</p></div><div><p>
Evaluates and ensures that all claims denied or underpaid inappropriately by Payers are identified, appealed and reversed</p></div><div><p>
Reviewing claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries and makes recommendations for resolution</p></div><div><p>
Ensures that targets are met for department Turnaround time, Quality and Productivity</p></div></ul>
</div>
</div></div></div><div><div><div><div><h4 class="jobSectionHeader"><b>Education, Experience, and skills needed</b></h4><ul><div><p>
Education: Degree in any related field preferably life science background.</p></div><div><p>
Over 2 years&rsquo; experience in Revenue Cycle Management - Eligibility and Authorization, Claim Submission &amp; Resubmission. Both inpatient and outpatient experience preferred.</p></div><div><p>
Expert knowledge of medical conditions, treatments, procedures and standard codes</p></div><div><p>
Willingness to work in different shifts</p></div><div><p>
Willingness to work from a different facility</p></div><div><p>
Analytical skills to review the account before submission to payer and ensure all required data elements are correct as per the insurance and medical code sets</p></div><div><p>
Basic understanding of the billing and payer adjudication guidelines related to DHA</p></div><div><p>
Basic knowledge of medical terminology</p></div><div><p>
Proficiency in the use of PCs and MS Office suite</p></div><div><p>
Excellent in communication skills</p></div><div><p>
Understanding of the various RCM departments</p></div><div><p>
Fluent Arabic speaking skills</p></div></ul></div></div></div></div></div></div><p></p>

Senior Medical Billing Executives - Dubai

AHOLD Delhaize

<div><b>Category/Area of Expertise:</b> Risk Management &amp; Insurance<br>
<b>Job Requisition:</b> 483515<br>
<b>Address: </b>USA-NC-Salisbury-2110 Executive Drive
<br>
<b>Store Code: </b>Claims Management (5157503)
<br>
<br>
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop &amp; Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.<br>
<br>
<b>Position Summary:</b><br>
<br>
This role is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations to determine compensability or liability, evaluations, negotiations and settlements/denials of Workers' Compensation claims. This role has direct responsibility for managing the claim in its entirety while maintaining service and quality level targets.
<br>
<br>
This role is responsible, specialized technical work investigating and processing claims for self-insured claims programs. This role is the primary claim interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.<br>
<br>
<b>Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.</b><br>
<br>
<b>Applicants must be currently authorized to work in the United States on a full-time basis.</b><br>
<br>
<b>Principle Duties and Responsibilities:</b><br>
<br>
<b>Claims Management</b><br>
<ul><li>
Manage assigned Workers Compensation caseload within established targets and financial authority. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.</li><li>
Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.</li><li>
Analyze fact of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Brand bottom lines.</li><li>
Identify fraud indicators and actively pursue subrogation opportunities.</li><li>
Monitor and actively manage medical treatment with the goal of minimizing disability and fostering a successful re-entry to the workplace.</li><li>
Solid understanding of state and federal laws associated with employee relations, including, but not limited to: FMLA, and ADA,</li><li>
Closely monitor and manage prescriptions. Work with PBM to authorize prescriptions related to the injury.</li><li>
Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.</li><li>
Build and maintain effective relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.</li></ul><br>
<b>
Financial Impact Administration</b><br>
<ul><li>
Manage book of Workers' Compensation claims business up to $5 million with authority to settle/negotiate a single claim within their authority of up to $75,000 (Corporate Authority policy)</li><li>
Communicate ongoing causes of associate or customer injuries to Safety and Brands.</li><li>
Serve as the primary point of contact to address and resolve claim issues impacting associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.</li></ul><br>
<b>
Basic Qualifications:</b><br>
<ul><li>
Licensed adjuster (as appropriate by jurisdiction)</li><li>
Bachelor's degree or 4 years WC claims experience</li><li>
Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims.</li><li>
Knowledge of medical terminology involved in complex claims</li><li>
Strong negotiation skills.</li></ul><br>
<b>
Skills and Abilities:</b><br>
<ul><li>
Excellent interpersonal skills</li><li>
Ability to multi-task</li><li>
Attention to detail</li><li>
Excellent time management skills</li><li>
Strong analytical, planning, influence, communication, and presentation skills</li><li>
Demonstrates a personal acceptance of change and the ability to adapt and drive change</li><li>
Willingness and ability to train and mentor others</li><li>
Proficient in O365</li></ul>
ME/NC/PA/SC Salary Range: $63,440-$95,160
<br>
<br>
IL/MA/MD/NY Salary Range: $72,880 - $109,320
<br>
<br>
Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws.
<br>
<br>
#LI-SM1 #LI-hybrid<br>
<br>
At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent.<br>
<br>
Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.<br>
<br>
Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work.<br>
<br>
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.</div>

Analyst II Claims Adjuster

Nextcare

<div>
 <strong>
  <strong>
   Key Responsibilities
  </strong>
  /What You Do
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Represent the Global Claims Risk Unit as a Fraud Management Subject Matter Expert(SME) for cross functional activities, Client Updates, New Business Solutions and Auditing
  </li>
  <li>
   Analyze claims data to identify unusual patterns and potential fraud indicators.
  </li>
  <li>
   Support the Fraud Analysts throughout the Fraud Process (Identification, Investigation, Corrective Actions)
  </li>
  <li>
   Conduct thorough investigations into suspicious claims, including interviewing claimants and gathering relevant documentation.
  </li>
  <li>
   Utilize advanced analytics and fraud detection tools to enhance fraud detection capabilities.
  </li>
  <li>
   Perform detailed data analysis to uncover trends and anomalies indicative of fraudulent activities.
  </li>
  <li>
   Prepare comprehensive reports on findings, including actionable recommendations.
  </li>
  <li>
   Participate in cross-functional teams to develop and implement fraud prevention strategies.
  </li>
  <li>
   Ensure all fraud detection and investigation activities comply with internal policies, external regulations, and industry standards.
  </li>
  <li>
   Maintain accurate and detailed records of investigations and outcomes.
  </li>
  <li>
   Prepare and present fraud reports to senior management and stakeholders.
  </li>
  <li>
   Identify opportunities to enhance fraud detection and prevention processes.
  </li>
  <li>
   Stay current with industry trends, emerging threats, and new technologies in fraud prevention.
  </li>
  <li>
   Provide training and guidance to junior fraud analysts and other staff on fraud detection techniques and best practices.
  </li>
  <li>
   Mentor team members, fostering a culture of vigilance and proactive fraud prevention.
  </li>
  <li>
   Take part in other projects when required, review documentation and contribute where applicable, research information relating to your area and provide feedback.
  </li>
  <li>
   Other Ad hoc duties as required
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  AI READINESS
 </strong>
 Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use
 <br/>
 <br/>
 <strong>
  Key Requirements/What You Bring
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Bachelor&rsquo;s degree in any Medical field, Finance, Business Administration, Insurance, or a related field preferred.
  </li>
  <li>
   At least 5 years&rsquo; experience in analysing and assessing medical claims of high values and complexities
  </li>
  <li>
   With proven track record in Fraud mitigation
  </li>
  <li>
   Strong ability to communicate effectively with various audiences and all levels of the organisation
  </li>
  <li>
   Proficiency in MS Office (in particular in Excel, Power BI, PowerPoint)
  </li>
  <li>
   Excellent level of written and verbal English is essential.
  </li>
  <li>
   High level of solution orientation &amp; decision making
  </li>
  <li>
   Have obtained or be working towards 1 or more of the following:
  </li>
  <li>
   Fraud (eg ACFE
  </li>
  <li>
   Medical Qualification
  </li>
  <li>
   Data Analytics
  </li>
  <li>
   International Medical Coding
  </li>
  <li>
   Legally permitted to work in the country of operations.
  </li>
  <li>
   Hybrid working option available as per business requirements.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  How we hire
 </strong>
 Allianz Partners does not accept unsolicited CV&rsquo;s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.
 <br/>
 <br/>
 <strong>
  Key Benefits/What We Offer
  <br/>
  <br/>
 </strong>
 Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance.
 <br/>
 <br/>
 Our products are embedded seamlessly into our partners&rsquo; businesses or sold directly to customers and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel and Allianz Care. Present in 75 countries, our 21,100 employees speak 70 languages, handle over 71 million cases each year, and are motivated to go the extra mile to offer peace of mind to our customers around the world.
 <br/>
 <br/>
 We at Allianz believe in a strong inclusive culture that encourages people to speak their minds, get involved and question the status quo. We are proud to be an equal opportunity employer and encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love, or what you believe in.
 <br/>
 <br/>
 We therefore welcome applications regardless of race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability, sexual orientation, or any other characteristics protected under applicable local laws and regulations.
 <br/>
 <br/>
 At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions. All while ensuring human oversight for claims to maintain service integrity. By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.
 <br/>
 <br/>
 Great to have you on board. Let's care for tomorrow.
</div>


Senior Fraud Analyst

Medi Assist Insurance TPA Private Limited

<p>Dear Candidate,</p><p>Greetings from Paramount Group !</p><p>Kindly find the below Company and job description for your perusal.</p><p>Paramount is servicing more than 17000 hospitals and nursing homes and about 650 diagnostic centres where cashless facility can be availed by the insured.<br/>Moving towards the National Health coverage, we also cater to the central and state govt. schemes. We are managing presently the following policies namely Mahatma Jyotiba Phule Jab Arogya Yojana - Maharashtra, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana - Mizoram &amp; Nagaland and Swasthya Sathi - West Bengal.</p><p>We operate across India with over 2000 people working to ensure outstanding services and support everyday extending to over 33 million lives insured with more than 25 Insurance companies including over 3000 corporate clients. Paramount has its Head Office in Mumbai with over 25 and around 50 Resident Representatives across the country.</p><p>Medical scrutiny of reimbursement claims<br/>Proper scrutiny of medical documents received from the hospital/ patient and ask for relevant details to corroborate with the available diagnosis.<br/>Review the treatment details/ medication regimen given during hospitalization and ask for justification from treating doctor if treatment protocol is not appropriate to the diagnosis<br/>Collate the medical details with the applicable policy terms to arrive at the final decision of claims adjudication.<br/>To resolve employees&rsquo;/claimant&rsquo;s medical queries</p><p>Education-BAMS/BHAMS</p><p>Intrested Please share cv on email-neelam.gupta@paramounttpa.com</p><p>Job Types: Full-time, Permanent</p><p>Pay: ₹20,000.00 - ₹30,000.00 per month</p><p>Benefits:</p><ul><li>Health insurance</li><li>Provident Fund</li></ul><p>Work Location: In person</p>

Medical Officer

<div><b>Category/Area of Expertise:</b> Risk Management &amp; Insurance<br>
<b>Job Requisition:</b> 483515<br>
<b>Address: </b>USA-MA-Quincy-1385 Hancock Street
<br>
<b>Store Code: </b>Claims Management (5157503)
<br>
<br>
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop &amp; Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.<br>
<br>
<b>Position Summary:</b><br>
<br>
This role is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations to determine compensability or liability, evaluations, negotiations and settlements/denials of Workers' Compensation claims. This role has direct responsibility for managing the claim in its entirety while maintaining service and quality level targets.
<br>
<br>
This role is responsible, specialized technical work investigating and processing claims for self-insured claims programs. This role is the primary claim interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.<br>
<br>
<b>Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.</b><br>
<br>
<b>Applicants must be currently authorized to work in the United States on a full-time basis.</b><br>
<br>
<b>Principle Duties and Responsibilities:</b><br>
<br>
<b>Claims Management</b><br>
<ul><li>
Manage assigned Workers Compensation caseload within established targets and financial authority. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.</li><li>
Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.</li><li>
Analyze fact of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Brand bottom lines.</li><li>
Identify fraud indicators and actively pursue subrogation opportunities.</li><li>
Monitor and actively manage medical treatment with the goal of minimizing disability and fostering a successful re-entry to the workplace.</li><li>
Solid understanding of state and federal laws associated with employee relations, including, but not limited to: FMLA, and ADA,</li><li>
Closely monitor and manage prescriptions. Work with PBM to authorize prescriptions related to the injury.</li><li>
Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.</li><li>
Build and maintain effective relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.</li></ul><br>
<b>
Financial Impact Administration</b><br>
<ul><li>
Manage book of Workers' Compensation claims business up to $5 million with authority to settle/negotiate a single claim within their authority of up to $75,000 (Corporate Authority policy)</li><li>
Communicate ongoing causes of associate or customer injuries to Safety and Brands.</li><li>
Serve as the primary point of contact to address and resolve claim issues impacting associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.</li></ul><br>
<b>
Basic Qualifications:</b><br>
<ul><li>
Licensed adjuster (as appropriate by jurisdiction)</li><li>
Bachelor's degree or 4 years WC claims experience</li><li>
Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims.</li><li>
Knowledge of medical terminology involved in complex claims</li><li>
Strong negotiation skills.</li></ul><br>
<b>
Skills and Abilities:</b><br>
<ul><li>
Excellent interpersonal skills</li><li>
Ability to multi-task</li><li>
Attention to detail</li><li>
Excellent time management skills</li><li>
Strong analytical, planning, influence, communication, and presentation skills</li><li>
Demonstrates a personal acceptance of change and the ability to adapt and drive change</li><li>
Willingness and ability to train and mentor others</li><li>
Proficient in O365</li></ul>
ME/NC/PA/SC Salary Range: $63,440-$95,160
<br>
<br>
IL/MA/MD/NY Salary Range: $72,880 - $109,320
<br>
<br>
Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws.
<br>
<br>
#LI-SM1 #LI-hybrid<br>
<br>
At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent.<br>
<br>
Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.<br>
<br>
Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work.<br>
<br>
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.</div>

Seneca Nation Health System

<div>
 <strong>
  Basic Function
  <br/>
  <br/>
 </strong>
 Position reviews reimbursements from carriers, determines denial classifications and develops justifications for making billing changes to improve and increase revenue flow for the Seneca Nation Health System (SNHS). Routinely monitors accounts receivable to identify and resolve billing discrepancies.
 <br/>
 <br/>
 <strong>
  General Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Monitors changes in medical insurance industry and adjusts billing procedures accordingly based on individual carrier policies, communicates changes to billing and coding staff to improve quality and quantity of work processed for a clean claims submission.
  </li>
  <li>
   Investigates reimbursement problems from improper coding and billing. Advise appropriate staff assisting with CPT, ICD 10, CDT and HCPC coding and documentation to decrease claim errors and increase third party payer revenue.
  </li>
  <li>
   Provides excellent customer service while initiating inquiries, reconsiderations and appeals to resolve difficult claim issues and delinquent accounts by contacting insurance carriers via mail, email, phone or fax to obtain claim or policy information.
  </li>
  <li>
   Reviews all outstanding balance reports through patient accounting system addressing unpaid claims and contacting the carriers with resubmissions, corrections or adjustments before the timely filing is exceeded.
  </li>
  <li>
   Acts as a resource to promote cooperative staff efforts and provide and maintain high quality service to patient, physicians and other staff.
  </li>
  <li>
   Identifies issues that may be related to the master ICD10, CPT, CDT, HCPC and insurance carrier list data files and advises appropriate staff that can review and make corrections for a resolution.
  </li>
  <li>
   Assures confidentiality of information according to the Privacy Act of 1974, HIPAA and all SNHS policies.
  </li>
  <li>
   Ensures compliance with applicable federal, state, and payer specific regulations.
  </li>
  <li>
   Maintains and enhances professional growth and development by staying updated with the latest technologies and industry trends in the insurance field.
  </li>
  <li>
   Knowledge of provider enrollment and insurance contracting.
  </li>
  <li>
   General knowledge of patient registration, billing clerk and other business office positions to provide coverage and direction when needed.
  </li>
  <li>
   Upholds and promotes the value and integrity of the Seneca Nation Health System (SNHS)&rsquo;s mission statement. Will promote SNHS in a positive manner.
  </li>
  <li>
   Provides care through a trauma-informed lens by incorporating key principles of both physical and psychological environment safety, trustworthiness and transparency, collaboration of decision-making during interactions, empowerment of patients by recognizing and building upon individual strengths, as well as recognizing and respecting the diversity of cultural backgrounds and sensitivity.
  </li>
  <li>
   Participates and completes all mandatory staff meetings, trainings, and in-services.
  </li>
  <li>
   Follows all policies and procedures of the department, SNHS, and Seneca Nation.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Knowledge, Skills, &amp; Abilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Excellent interpersonal communication skills
  </li>
  <li>
   Strong time management and organizational skills
  </li>
  <li>
   Ability to provide and recommend solutions to problems
  </li>
  <li>
   Ability to absorb critical information and instructions
  </li>
  <li>
   Excellent analytical and problem - solving skills
  </li>
  <li>
   Computer proficient in data entry and spreadsheet applications
  </li>
  <li>
   Knowledge of medical terminology, coding policies and procedures
  </li>
  <li>
   Able to collect, organize and interpret data from carriers with initiative to develop and implement changes in coding and billing while prioritizing workloads with multiple tasks
  </li>
  <li>
   Must be able to adapt to a quickly changing electronic healthcare environment
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   High School graduate or equivalent is required.
  </li>
  <li>
   Associate&rsquo;s degree or AHIMA, AAPC, or AMBA certification with five years of experience in reimbursement, coding and clerical work in a hospital or medical setting is preferred.
  </li>
  <li>
   Experience working in a mental health facility, hospital, medical center, outpatient health care setting, or Indian Health Service (IHS)/tribal health, preferred.
  </li>
 </ul>
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Insurance Reimbursement Specialist

Search 10000+ Medical claims analyst jobs near you this March. New roles added regularly across leading industries. Apply today.

10000 medical claims analyst jobs Near Me

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Insurance Reimbursement Specialist