medical claims analyst

RiseIT Solutions

<div><div><b>Title: Epic Claims Analyst</b></div>
<div>Location: 100% Remote</div>
<div>Type: Contract</div>
<div>Rate: DOE</div>
<div>Education: College Bachelors + Certifications</div>
<div></div><div>The Epic Claims Analyst is responsible for establishing credibility at all levels and builds problem-solving partnerships with customers and colleagues. The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive information systems. Documents workflows, system configuration, and change control documentation.</div>
<div></div><div>Confers with professional staff to ascertain specific requirements and assists in the completion of programming specifications. This requires the individual to stay current with the system and/or application as well as interfacing with the appropriate department and external analysts. Must employ excellent communication skills in sharing information with users within the department.</div>
<div></div><div>Qualifications</div>
<div></div><div>Minimum Education &amp; Experience:</div>
<ul><li>An approved equivalent combination of education and experience.</li></ul>
<ul><li>Healthcare Experience preferred.</li></ul>
<div>o Level 1 Not EPIC certified and less than 2 years experience</div>
<div>o Level 2 EPIC certified and 2 plus years experience</div>
<div>o Level 3 EPIC certified and 5 plus years experience</div>
<div></div><div>Required Certification/Registration:</div>
<ul><li>Epic Reimbursement and Contract Management.</li></ul>
<div></div><div>Skills and Abilities Required:</div>
<ul><li>Proficiency in more than two computer environments or platforms.</li></ul>
<ul><li>Ability to work with a computer terminal for extended periods of time.</li></ul>
<ul><li>Ability to handle multiple projects.</li></ul>
<ul><li>Ability to handle stressful situations.</li></ul>
<ul><li>Ability to work independently with little supervision</li></ul>
<ul><li>Ability to solve problems</li></ul>
<ul><li>Excellent technical aptitude</li></ul>
<ul><li>Excellent interpersonal skills</li></ul>
<ul><li>Excellent organizational skills</li></ul>
<ul><li>Excellent training skills</li></ul>
<ul><li>Flexible and effective in a team environment</li></ul></div><div></div>

Epic Claims Analyst

NeighborHealth

<div><div><p><b>Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center!</b></p><p></p><p>
As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities.</p></div><p></p><div><p>
Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly &mdash; every role at NeighborHealth is vital. Together, we&rsquo;re advancing medicine and delivering the best care experience for our patients and community!</p></div><p></p><div><div><div><p>
Interested in this position? Apply online and create a personal candidate account!</p></div></div></div><p></p><p><b>
Current Employees of </b><b>NeighborHealth</b>- Please use our internal careers portal to apply for positions.</p><p></p><p>
To learn more about working at NeighborHealth and our benefits, please visit out our Careers Page.</p><p></p><p><b>
Time Type:
</b></p>Full time<p></p><p><b>
Department:
</b></p>PACE Health Plan Management<p></p><p><b>
All Locations:
</b></p>300 Ocean Avenue &ndash; Revere<p></p><p><b>
Position Summary:
</b></p>Position Summary:
<br>
The Claims Analyst, under the direction of the Manager of PACE Claims, is responsible for the overall claims adjudication and insurance validation process. This includes:<div>
Claims Department:<br>
<ul><li>Maintaining up-to-date knowledge of fee schedules for both Medicare and MassHealth.</li><li>Ensuring the fee schedules are updated and are priced correctly in the Tapestry module.</li><li>Auditing adjudicated claims to ensure payments are made in accordance with their contracts.</li><li>Analyzing claims data to ensure accruals are reported to Finance in a timely and accurate manner.</li><li>Ensuring accuracy of claims-related cost reports.</li><li>Analyzing claims data for trends (e.g., referral matching).</li><li>Reporting any findings to PACE leadership.</li><li>Coordinating with IT to enhance and refine the claims adjudication process.</li><li>Coordinating with the Manager of PACE Claims to proactively review referrals and claims-related data in an effort to provide utilization reports to other departments.</li></ul></div><div>
Insurance Department:<br>
<ul><li>Must maintain up-to-date knowledge of Coordination of Benefits.</li><li>In conjunction with the Supervisor of Business Services, responsible for assisting with and developing workflows to maintain overall compliance of the Insurance Department.</li></ul></div><p>
Schedule: Monday - Friday 8:00am - 5:00pm</p><p><b>
Insurance Department</b></p><ul><li>
Serves as the department Medicare expert. This includes auditing enrollment files to ensure compliance with the Part D requirements: EOBs, COB follow-up is completed timely and accurately, as well as documentation in EPIC regarding MSP surveys and TrOOP.</li><li>
Ensures primary insurance coverage is documented in EPIC and that insurance billing is appropriate.</li><li>
Responsible for the timely completion and documentation of CMS Part D reports: COB, MSP.</li><li>
Serves as back-up for Business Services Supervisor.</li></ul><p><b>
Expense Management/Claims</b></p><ul><li>
Monitors monthly expense reports to ensure that all expenses are correctly categorized and reported.</li><li>
Oversees the referral authorization process as it relates to timely and accurate claims payment and improvements to utilization management.</li><li>
Responsible for maintaining up-to-date knowledge of fee schedules and works with IT to ensure timely upload into Tapestry.</li><li>
Coordinates with the Manager of PACE Claims in an effort to improve the processes to manage claims payment and expenses based on trends analysis.</li><li>
Acts as the department claims expert regarding adjudication.</li><li>
Audits claims work queues to ensure timely and appropriate payment to vendors; suggests process improvements (e.g., referral matching table edits).</li><li>
Coordinates with Finance to ensure appropriate accruals on a monthly basis. Reviews IBNR data with Finance in an effort to ensure all claims are received.</li><li>
Works closely with the Contracts Department to review reimbursement.</li></ul><p><b>
Information Technology</b></p><ul><li>
Serves as a liaison with IT, specifically regarding Tapestry (fee schedule development, claims processing, referrals) and reports and workflows related to ESP (Elder Service Plan) Business Office processes.</li></ul><p><b>
Other Duties</b></p><ul><li>
Regularly reports to work on time and follows attendance and call-in procedures.</li><li>
Works cooperatively and respectfully with others at all levels of the organization.</li><li>
Takes the initiative to perform a wide variety of activities and be flexible in terms of work assignments based on operational needs, contributing to the smooth functioning of the department.</li><li>
Displays outstanding customer service skills when interacting with all NH customers according to the PACE model.</li><li>
Creates and/or revises policies and procedures, workflows, and guidelines, as appropriate, in any respective areas under the Business Office or as requested by Manager.</li><li>
Other duties as required.</li></ul><p><b>
PACE AND GENERAL REQUIREMENTS: KNOWLEDGE, SKILLS AND ATTITUDES</b> (This section not applicable to initial assessment; all ESP employees and contractors attain these competencies through participation in PACE and TJC orientation programs.)</p><ul><li>
Demonstrates commitment to the PACE mission by actively promoting the autonomy and dignity of PACE program participants.</li><li>
Demonstrates commitment to a holistic approach to care by actively engaging in interdisciplinary team planning and communication processes.</li><li>
Demonstrates commitment to participant-centered care by actively engaging participants and/or Health Care Proxies in discussion about self-management goals.</li><li>
Understands ESP&rsquo;s organizational structure. Actively participates in NH programs and committees.</li><li>
Demonstrates the ability to communicate effectively and respectfully through verbal and written skills. Documents in accordance with protocol.</li><li>
Demonstrates knowledge of Participant Rights by:</li><li>
actively protecting rights to privacy;</li><li>
always treating participants with respect;</li><li>
encouraging and assisting participants in filing of complaints and grievances;</li><li>
helping to maintain a clean and safe environment;</li><li>
helping to ensure that restraint and involuntary seclusion are never used as a means of coercion, discipline, punishment, retaliation, or for the convenience of staff; and that those restraints, when required by extraordinary circumstance, are always applied and monitored in accordance with policy/procedure.</li><li>
Promotes a sense of &ldquo;teamwork&rdquo; through demonstration of self-direction and self-motivation. Solves problems independently or knows when to seek consultation. Provides leadership to other support staff on the practice team. Works cooperatively and respectfully with others at all levels of the organization.</li><li>
All ESP employees participate in the orientation, training, and mentoring of new employees and in providing input for continuous improvement.</li><li>
Displays outstanding customer service skills when interacting with ESP participants, family members, outside providers, potential ESP members, referral sources, or others.</li><li>
Interacts with participants in a professional and respectful manner that reflects the needs and concerns of the individual. Maintains a positive attitude. Uses communication devices appropriately.</li><li>
Demonstrates commitment to performance improvement by reporting incidents and other data used in ESP Performance Improvement activities, and by actively participating in one or more performance improvement committees or making a minimum of two suggestions for program or other improvements over the course of the year.</li><li>
Responsible for continued professional growth and development.</li></ul><p><b>
Pay Range: </b>Starting at $26/hr up to $39/hr based on experience</p><p><b>
EEO &amp; Accommodation Statement:</b></p><p>
NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to HRrecruit@NeighborHealth.com or call 617-568-4480 to let us know the nature of your request</p><p><b>
Federal Trade Commission Statement:</b><br>
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or &ldquo;apps.&rdquo; Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.</p><p><b>
E-Verify Program Participation Statement:</b></p><p>
NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.</p></div>

Analyst, Claims

Speak Viral

<p>The <b>Medical Billing Supervisor</b> is responsible for overseeing and executing the end-to-end medical billing process, ensuring accuracy, compliance, and timeliness in claims submission, payment posting, and account reconciliation. This role requires strong analytical skills, attention to detail, and extensive knowledge of healthcare billing regulations and payer requirements. The Senior Executive will also mentor junior team members and collaborate with internal departments to optimize revenue cycle performance.</p><p><b>Key Responsibilities:</b></p><ul><li>Preparing and submitting billing data and medical claims to insurance companies.</li><li>Ensuring the patient&rsquo;s medical information is accurate and up to date.</li><li>Preparing bills and invoices, and documenting amounts due for medical procedures and services.</li><li>Collecting and reviewing referrals and pre-authorizations.</li><li>Monitoring and recording late payments.</li><li>Following up on missed payments and resolving financial discrepancies.</li><li>Examining patient bills for accuracy and requesting any missing information.</li><li>Investigating and appealing denied claims.</li><li>Helping patients develop patient payment plans.</li><li>Maintaining billing software by updating rate change, cash spreadsheets, and current collection reports.</li></ul><p><b>Qualifications:</b></p><ul><li>Bachelor&rsquo;s degree in business, health care administration, accounting, or a relevant field.</li><li>A minimum of 4 years of experience as a medical biller or similar role.</li><li>Solid understanding of billing software and electronic medical records.</li><li>Must have the ability to multitask and manage time effectively.</li><li>Excellent written and verbal communication skills.</li><li>Outstanding problem-solving and organizational abilities.</li></ul><p>Job Type: Full-time</p><p>Pay: Rs60,000.00 - Rs100,000.00 per month</p><p>Application Question(s):</p><ul><li>Will you be able to work in night shift(7pm to 4am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul><p>Work Location: In person</p>

Medical Billing Supervisor

Omaha National Group

<div><div><b>Investigations Analyst (Entry Level)</b></div>
<div><br>
<b>Job Description</b></div>
<div><br>
Omaha National is seeking an Investigations Analyst to join our growing team. The right candidate is insightful and internet savvy, with the ability to research and locate information not immediately obvious to the general public. Prior workers' compensation experience is not required; we will provide the right candidate the training needed to engage in a rewarding career.</div>
<div><br>
Utilizing popular search engines, social media, phone calls, and other investigative means, the Investigations Analyst gathers and delivers facts in a concise and objective manner to identify and prevent potentially fraudulent behavior. We are looking for an inquisitive, resourceful, persuasive, and detail-oriented individual who is proficient in utilizing internet-based and other investigative resources to locate a wide variety of information. This position requires strong negotiation and rapport-building skills, a high aptitude to learn complex medical and legal principles, and the ability to thrive in a challenging and fast paced role.<br>
<br>
This is one of the most important jobs in our company: it has a significant impact on our financial success as well as on the lives of many individuals.<br>
<br>
<b>RESPONSIBILITIES:</b></div>
<ul><li>Use social media and other internet resources, as well as specific websites and applications, to uncover activities of injured workers that are inconsistent with their reported disability status.</li>
<li>Partner with key internal employees in areas such as Claims Legal, Medical Utilization Review, Medical Bill Review, and Medical Networks to ensure ideal outcomes.</li>
<li>Determine coverage and compensability for reported claims.</li>
<li>Set and maintain appropriate reserves.</li>
<li>Maintain compliance with regulatory deadlines, benefit calculations, state reporting, and benefit notices.</li>
<li>Achieve favorable settlements through timely identification of settlement opportunities, accurate settlement valuations, and effective negotiation practices.</li>
<li>Direct vendors such as field investigators, field nurses, and defense attorneys to positively impact outcomes.</li>
</ul><div><b>REQUIREMENTS:</b></div>
<ul><li>A keen, logical mind and a strong aptitude for analytical thinking</li>
<li>Rock-solid honesty, openness, and ethical values</li>
<li>Strong analytical skills and attention to detail.</li>
<li>The ability to verify information and identify issues and inconsistencies; a strong BS detector is a must.</li>
<li>Ability to comprehend, interpret, and apply complex legal and medical documents.</li>
<li>Strong spoken and written communication skills with the ability to effectively communicate with a broad audience of varying backgrounds, frequently conveying complicated information in a way easily understood by a layperson, with a natural strength for both investigative and persuasive communication.</li>
<li>Prior workers' compensation experience is not necessary; we will provide the training.</li>
<li>Bachelor&rsquo;s degree a plus but not required.</li>
</ul><div><div><b>BENEFITS:</b><br>
Omaha National provides a stable, positive work environment, competitive pay, excellent benefits, such as paid parental bonding leave, tuition reimbursement, 401K, and paid vacation and sick leave.</div></div></div><div></div>

Investigations Analyst (Entry Level)

ClaimCare Solution

<div><p>Ready to turn data into decisions that matter? <b>ClaimReturn</b>, located in Farmers Branch, TX, is hiring a <b>full-time System Data Analyst</b> to join our innovative team. If you're passionate about transforming complex data into actionable insights, apply today and take the next step in your career!</p><p>
At ClaimReturn, we believe in rewarding talent. As our System Data Analyst, you'll earn up to <b>$85,000 per year</b>, plus <b>eligibility for a discretionary incentive</b> once available. We also offer <b>excellent benefits and perks</b>, including:</p><ul><li>
Virtual healthcare</li><li>
Discount dental and vision - no employee monthly premiums (100% employer paid)</li><li>
Generous PTO</li></ul><p>
</p><p><b>THE INS AND OUTS OF BECOMING OUR SYSTEM DATA ANALYST</b></p><p>
YOUR ROLE:</p><p>
In this full-time role, you'll architect end-to-end audit systems, streamline workflows, and bring data to life through Power BI dashboards and visualizations. Your day will include leveraging SQL and Azure Data Factory to keep data pipelines flowing, solving problems with sharp analytical thinking, and exploring AI concepts to enhance systems, all while partnering with cross-functional teams to deliver results that matter.</p><p>
OUR REQUIREMENTS:</p><ul><li>
Bachelor's degree in data analytics, computer science, information systems, or related field</li><li>
Experience within healthcare data</li><li>
Proven ability to manage multiple complex projects with close attention to detail</li><li>
Strong interpersonal, analytical, and technical skills</li><li>
Passionate about turning challenges into opportunities</li></ul><p>
</p><p><b>JOIN US AT CLAIMRETURN</b></p><p>
ClaimReturn is a leader in healthcare data analytics and recovery services, helping clients uncover hidden savings and recover improperly paid medical claims with precision and integrity. Powered by advanced AI and analytics, we're shaping the future of medical cost containment while minimizing abrasion with providers, plans, and members. Our team thrives in a culture of innovation and collaboration, where your expertise is valued, your ideas drive real impact, and your work helps make healthcare more efficient for everyone.</p><p>
Join a team that values innovation, growth, and impact. Our initial application process is quick, easy, and mobile-friendly, so you can start your journey with ClaimReturn in minutes. Apply now and take the first step toward shaping the future of healthcare data!</p></div>

System Data Analyst

AIT Global Inc

<p><b>Job Title: Data Analyst with Healthcare / Medicaid</b><br/><b>Location: Remote</b></p><ul><li>6&ndash;10 years of experience as a Data Analyst(or Analytics Engineer)</li><li>Strong SQL skills (complex joins, window functions, aggregations)</li><li>Experience working with large, messy, real-world datasets</li><li>Exposure to healthcare, claims, or financial data</li><li>Proven ability to explain why numbers do not match</li><li>Strong documentation and analytical thinking skills</li></ul><p>Job Type: Part-time</p><p>Experience:</p><ul><li>6 - 10: 6 years (Preferred)</li></ul><p>Work Location: Remote</p>

Data Analyst (Medicaid)

Anderson Hospital

<div><p><b>Job Summary</b><b>: Bills Auto, Attorney and Personal Injury cases, as well as Workers Compensation claims. Reviews and analyzes unpaid claims, determining action steps for follow-up and claim resolution. Is main point of contact for attorneys, accident adjusters, workers compensation adjusters, and accident/workers compensation patients. Is consultant to Patient Account Analyst for accident-related and workers compensation related credit balances. Is consultant to billing teams for health insurance claims for accident-related and workers compensation accounts.</b></p><p>
</p><p><b>Job Responsibilities:</b></p><ul><li><b>
Contacts patients after accident services for possible auto or personal injury no fault or liability insurance sources.</b></li><li><b>
Bills claims for auto, attorney , personal injury cases, and workers compensation.
</b></li><li><b>Bills claims accurately and in compliance with government and other payor regulations and guidelines.</b></li><li><b>
Liaison to PFS Director in lien processing and settlement requests.</b></li><li><b>
Prepares attorney requests for itemized billing and files liens as appropriate. Handles all attorney related correspondence and calls.</b></li><li><b>
Completes needed follow-up, working to manage outstanding Accident and Workers Compensation AR.</b></li><li><b>
Works with third party attorney for complex cases.</b></li><li><b>
Other duties as assigned.</b></li><li><b>
Identifies and recommends opportunities for process improvement in Patient Financial Services, or other Revenue Cycle departments, as related to the PFS processes.</b></li></ul><p><b>
Education Requirements and Other Requirements:</b></p><p>
Education Level: High school diploma or equivalent.</p><p>
At least 3 years experience with working with Accident and Workers Compensation claims.</p></div>

BILLER AND ANALYST,ACCIDENT AND WORKERS COMPENSATION - PATIENT FINANCIAL SERVICES - FT DAYS

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