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Claims Analyst - Hospital Billing or Provider Claims - MA #3427

Ray Miller Staffing Associates
Somerville, Massachusetts, United States
$60-$75 K
November 19, 2016

Posted By Premium Recruiter


Position Title Claims Analyst - Hospital Billing or Provider Claims - MA #3427

Relocation No

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.