Claims Analyst
Claims Analyst
Claims Analysts review submitted insurance claims for accuracy and compliance with payer guidelines. They identify discrepancies, resolve issues, and ensure that claims are processed correctly and promptly. Their work reduces claim rejections and ensures that healthcare providers maximize their reimbursements while maintaining adherence to industry regulations.
Job Description:
- Review and analyze insurance claims to ensure they are accurate, complete, and comply with payer policies.
- Process and adjudicate claims, identifying any errors or discrepancies that could result in denials or underpayments.
- Collaborate with healthcare providers, patients, and insurance companies to resolve issues related to claims, ensuring timely reimbursement.
- Ensure that all claims are submitted according to proper coding and billing guidelines, adhering to payer-specific rules.
- Perform follow-up on unpaid claims, working with insurance companies to resolve discrepancies and expedite payment.
- Investigate and analyze denials, identifying root causes and suggesting improvements to prevent future issues.
- Provide reports on claims status, trends, and analysis for management teams to improve the overall claims process.
- Stay updated on healthcare regulations, payer policies, and industry standards to ensure compliance with all necessary guidelines.
Desired Candidate Profile:
- Proven experience as a Claims Analyst or similar role in medical billing or insurance claims processing.
- Strong knowledge of healthcare insurance policies, medical coding (ICD-10, CPT, HCPCS), and billing procedures.
- Ability to analyze and process claims accurately and efficiently while ensuring compliance with payer requirements.
- Excellent problem-solving skills to address claim denials, discrepancies, and underpayments.
- Strong communication skills for interacting with insurance companies, healthcare providers, and patients.
- Proficient in using healthcare management software, medical billing platforms, and MS Office applications.
- Detail-oriented with the ability to handle complex claims and identify errors.
- Certification in medical billing or claims management (e.g., Certified Professional Coder (CPC), Certified Claims Professional (CCP)) is a plus.