Medical Claims Analyst

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

Working Conditions

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Skills Required

Medical Billing