- Reviews claims and appeals for accuracy, completeness, and eligibility.
- Analyze and audit claims to ensure compliance and provide solutions to resolve claims errors.
- Creates financial estimates on a weekly basis using Microsoft Excel.
- Provides feedback and justification of denied claims to providers, as needed.
- Aids providers on how to submit claims and verification of participant's eligibility.
- Conducts basic contract review to confirm payment rates.
- Collaborates with other departments in the organization.
- Requests monthly inventory tracker from TPA (Third Party Administrator)
- Conducts follow-up activity for claims held until the claim is closed.
- Confirms that claims are associated with pre-authorizations from the Interdisciplinary Team (IDT) and/or Primary Care Provider.
- Conducts coordination of benefits, insuring that claims impact primary and secondary insurance, as appropriate.
- Reviews and analyzes claims loss, expense reserves and reconciles claims reports with authorization sheets.
- Processes new claims and disseminates the claims to TPA.
- Reports claims issues to IDT, Primary Care Providers, Vice President of Finance and other entities, as appropriate.
- Assists Claims Supervisor to identify exposures to the company and reports to senior-level management on pending claims and litigation that may have an adverse impact on corporate goals.
- Assists Claims Supervisor as a liaison between the TPA, provider network, insurance companies and other entities as needed.
- Checking pricing of claims through contracted rates and Medicare/Medicaid fee schedules.
- Demonstrates workplace behavior that promotes organizational core values of honesty and integrity, respect for others, encouragement, high quality care and patient-centeredness.
- Attend and participate in staff meetings, in-services, projects, and committees as assigned.
- Adhere to and support the center's practices, procedures, and policies including assigned break times and attendance.
- Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
- Be flexible in schedule of hours worked.
- May require use of personal vehicle.
- Proficient knowledge of computer skills. MS Office (Word, Excel, Access, PowerPoint, Publisher and Outlook). Candidates will take a Microsoft Office proficiency exam before being offered a position.
- Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
- Excellent written, grammatical, reading comprehension and verbal skills required.
- Ability to quickly learn department policies, procedures, goals, and services.
- Ability to change priorities regularly.
- A minimum of a High School Diploma with two (2) years of relevant experience required.
- 2 +years of professional experience processing and analyzing claims is strongly preferred
- Ability to present information in one-on-one and group settings.
- Ability to communicate information in a professional and confident manner.
- Demonstrated ability in critical thinking, self-initiative, and self-direction.
- Understanding of physiology, medical terminology, and disease process. strongly preferred.
- Demonstrated PC skills in Word, Excel, and Microsoft Access
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Claims Analyst - Los Angeles, United States - INNOVATIVE INTEGRATED HEALTH INC
Description
The Claims Analyst is responsible for monitoring liability claims, verifying and updating information on submitted claims. Reviews contract information and policies to determine which charges are eligible for reimbursement. Ensures completeness and accuracy with claims processing in order to support the organization's revenue cycle.Skill:
Attention to detail and accuracy.
Qualifications
