Claims Resolution Analyst

Job Summary

A company is looking for a Claims Resolution Analyst I to process and adjudicate claims accurately and efficiently.

Key Responsibilities

• Independently adjudicate complex claims and ensure compliance with contractual terms and coding guidelines
• Review claim forms for completeness, validate coding accuracy, and determine appropriate payment amounts
• Collaborate with clinical staff to resolve issues related to incorrect coding and manage claim disputes

Required Qualifications

• One (1) or more years of experience in healthcare claims processing or as a resolution analyst
• Experience with HCPCS, CPT, and ICD-10 coding
• Knowledge of Medicare, Medicaid, self-funded, or commercial insurance payment methods
• Ability to maintain confidentiality and handle sensitive information
• Familiarity with MS Excel for daily tasks