CLAIMS RESOLUTION ANALYST
Job Posting for CLAIMS RESOLUTION ANALYST at Gainwell Technologies LLC
Job Description
Description
Perform routine but moderately complex tasks that are related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Apply knowledge of established procedures and policy to research and resolve customer questions or management requests utilizing policy manuals. Ensure that claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalates only the most complex issues to immediate supervisor. Examples of work performed may include preparing correspondence, report preparation, verifying data, researching, completing forms collections and data entry. Performs other duties as assigned. Involved in the training of new employees and may take the lead in areas of expertise. Document process and procedures.
- Entry and/or approval of medical Prior Authorizations.
- Entry and maintenance of third party insurance information to facilitate coordination of benefits and benefit recovery.
- Identification of accident related claims.
- Resolve suspended medical claims utilizing Medical Assistance Policy.
- Research, entry, and maintenance of HCPC and CPT codes.
- Entry of nursing home, hospital, federally qualified health centers and ambulatory surgical center rates.
Experience Required
High School education or equivalent
Typically requires 3 – 5 years general experience, or equivalent combination of experience and college-level education.
Healthcare, insurance or third-party billing experience helpful
- Excellent oral and written communication skills
- Ability to effectively prioritize and handle multiple tasks and work under aggressive time constraints
- Ability to provide quality customer service
- Excellent analytical, problem-solving and decision-making skills
- Self-motivated with excellent time management and organizational skills; ability to work independently
- Experience with Microsoft Outlook, Word and proficiency with Excel
- Ability to interpret healthcare policy, laws and regulations
Work Environment
- Office environment, onsite in Rhode Island
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