Claims Analyst

Claims Analysts -

The Claims Analysts will manually review pended claims that do not auto adjudicate or fail to process through the HAX system and pend. They will also be responsible for working special claims associated projects as assigned by the client and assist in working escalations and customer service tickets. The person applying for this position would require healthcare claims experience. You must have the ability to meet both production and quality standards with a high level of accuracy and proficiency. Experience using dual monitors & multiple systems simultaneously is preferred.

Core Responsibilities:

• Review electronically pended claims for resolution via payment or denial
• Review denied claims and correct for payment if necessary or finalize denials release
• Special claims assignments as received from Client.
• Assist escalations and provider service tickets.
• All other tasks as related to claims processing.

Expectations:

• Attend all training sessions.
• Adhere to time/attendance policies.

Qualifications:

• High School Diploma/GED required.
• Minimum of 1/ 3 years’ experience in claims processing
• Ability to meet production, quality, and accuracy standards.
• Minimum of 1/3 years’ experience within healthcare required (E.g., medical claims, billing, and coding)
• Working knowledge of Medical Terminology as it relates to healthcare claims administration.
• Knowledge of Explanation of Benefits (EOB), Coordination of Benefits (COB), HCFA claim forms and UB claim forms.
• Working knowledge of Medicare /Medicare replacement - Medicaid /Medicaid replacement plans as they relate to claims processing guidelines.
• Ability to work in a high production and high-quality standard environment with minimum supervision.
• Strong Computer Skills
• Experience with Microsoft Word, Excel, and Outlook
• Experience using dual monitors and multiple systems preferred.
• Excellent interpersonal and communication skills

Requirements:

• Ability to work from 8:00am – 4:30pm EST Monday thru Friday
• Ability to work the first 90 days with no absences
• Access to high speed internet
• Access to a distraction free environment during business hours

Job Type: Full-time

Salary: $16.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Remote

Education:

• High school or equivalent (Required)

Experience:

• Medical claims: 2 years (Required)
• Medical billing: 1 year (Required)
• Healthcare management: 1 year (Required)

Work Location: Remote

Salary : $16 - $0