Position Title Claims Analyst - Hospital Billing or Provider Claims - MA #3427
Location Somerville MA
Position Summary: Primarily responsible for identifying underpaid and/or denied claims through review of managed care contracts and policies and/or general billing and coding rules.
Essential Duties and Responsibilities:
Assemble hospital and physician clients contracts, historical and current reimbursement terms
Assemble hospital and physician client's billing policies and procedures
Summarize contract terms for each individual carrier and create summary sheets for each contract for claims review
Collect claims data to be reviewed and compare data to completed contract summary
Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
Build strong, lasting relationships with clients, payors and company personnel
Promotes positive public relations for the company, including maintaining a professional attitude and approach with all payors
Contact insurance companies and other payors to explain and resolve claim underpayments and denials and arrange for payment or adjustment processing on behalf of the client
Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting
Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other personnel
Support and direct claims to all departments and client onsite analysts
Attend client, department and company meetings
Comply with federal and state laws, company and department policies and procedures
Essential Skills and Experience:
Minimum of 3 years of experience in hospital billing or provider claims, including working knowledge of contracts and fee schedules
Minimum of 1 year experience working with collections
High School diploma or equivalent
Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
Organization and documentation skills to ensure timely follow-up and accurate record keeping
Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
Ability to present written routine correspondence (in English)
Ability to present ideas on complex, detailed issues with ease
Ability to define problems, collect data, establish facts and draw valid conclusions
Strong customer service orientation
Excellent interpersonal and communication skills
Strong team player
Commitment to company values
CPC Certification required
Associate or Bachelor's Degree preferred.
Bottom line requirements we need notes on with candidate submittal:
1. High School diploma or equivalent required. Associate's or Bachelor's degree preferred.
2. CPC Certification.
3. 3+ years of experience in hospital billing or provider claims.
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