Complex Claims Analyst - Healthcare Billing

Complex Claims Analyst

Healthcare Billing

PROMEDICAL is seeking a Complex Claims Analyst. This position is responsible for the initial billing and follow-up of unpaid or denied workers compensation & motor vehicle medical claims.

Analyst will ensure that claims are being billed correctly and that insurance carriers have the necessary information to adjudicate. A healthcare revenue cycle background in medical billing or insurance claim processing is a must and a candidate should be comfortable on the phone speaking to carriers, attorneys, patients and employers.

Analysts utilize on-line tools, system strategies, as well as actively communicate over the phone or via email.

This role requires a high level of attention to detail, strong organizational skills, and comfort with multitasking.

The successful candidate must respect confidentiality, and have strong computer skills. Must enjoy working in a team environment, be goal driven and possess the ability to meet deadlines and determine priorities.

Job Responsibilities of Claims Follow up Analyst:

• Provide a working knowledge in the area of Workers Compensation and Automobile Accident claims for states in which PROMEDICAL has clients
• Ensure claims are being liquidated in a timely manner and at the appropriate level or reimbursement
• Review and collect incoming documentation
• Troubleshoot specific accounts as needed
• Consistently change strategies within the database system
• Research claim information on-line and enter new data into existing claim system as information is received with goals of accuracy
• Respond to all inquiries from "customers" (defined as: patients, employers, attorneys, insurance companies, etc.) with goals of timeliness
• Make outgoing calls to customers on new claims as appropriate in order to keep the claims moving along a path toward ultimate payment
• Handle inbound phone calls from customers, consisting of hospitals and physician groups
• Converse with the variety of customers in the utmost professional manner, even in tense situations. Handle customer questions and complaints politely and efficiently
• Ensure PROMEDICAL is responding to similar information in an accurate and consistent manner
• Assist with special projects as needed

Qualifications include:

• High school diploma or equivalent and experience in an office environment
• Provide expertise in the area of Workers Compensation and Automobile Accident claims
• High attention to detail and accuracy
• Anticipate and solve problems to resolve issues
• Prioritize tasks, exercise sound judgment and confidentiality in maintaining sensitive information
• Learn new programs quickly, and demonstrate skills in the use of computers
• Sharp analytical skills
• Competent to work on multiple priorities and work under pressure
• Excellent communication and interpersonal skills in both orally and in written form

Physical requirements

• This job has minimal physical demands.

Direct reports

• n/a

Compensation & Location

• This is a temp to perm position offering a competitive hourly rate and a chance to join our team permanently
• This is a hybrid position with some days requiring working in our Lexington, MA office

Equal Opportunity Employer

• PROMEDICAL is proud to be an Equal Opportunity Employer.
• Applicants for all job openings are welcome and will be considered without regard to race, gender, age, national origin, color, religion, disability, military status, sexual orientation, or any other basis protected by applicable federal, state, or local laws.