job title:medical claims analyst(medmetrix)

Job Purpose

The Medical Claims Analyst is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites

• Meets and maintains daily productivity/quality standards established in departmental policies

• Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts

• Adheres to the policies and procedures established for the client/team

• Knowledge of timely filing deadlines for each designated payer

• Performs research regarding payer specific billing guidelines as needed

• Ability to analyze, identify and resolve issues causing payer payment delays

• Ability to analyze, identify and trend claims issues to proactively reduce denials

• Communicates to management any issues and/or trends identified

• Initiate appeals when necessary

• Ability to identify and correct medical billing errors

• Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process

• Understanding of under or over payments and credit balance processes

• Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required

• Act cooperatively and courteously with patients, visitors, co-workers, management and clients

• Work independently from assigned work queues

• Maintain confidentiality at all times

• Maintain a professional attitude

• Other duties as assigned by the management team

• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Understand and comply with Information Security and HIPAA policies and procedures at all times

• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Completed at least High School education

• Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)

• Experienced on medical billing/ AR Collections

• Background in calling insurance (Payer) to verify claim status and payment dispute

• Strong interpersonal skills, ability to communicate well at all levels of the organization

• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

• High level of integrity and dependability with a strong sense of urgency and results oriented

• Excellent written and verbal communication skills required

• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must be amenable to work night shifts

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.

• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

• Work Environment: The noise level in the work environment is usually minimal.