Claims Analyst

Job Summary

A company is looking for a Claims Analyst responsible for analyzing and reviewing claims for accuracy, completeness, and eligibility.

Key Responsibilities

• Analyze medical claims and review billing information, referring claims for further investigation as needed
• Document and investigate claims before payment and resolve discrepancies with third-party billers
• Manage fee schedules in the software system and communicate with interdisciplinary teams regarding unauthorized services

Required Qualifications

• High school diploma or equivalent required; Bachelor's degree preferred
• Familiarity with ICD-9-CM, ICD-10-CM, and CPT coding required
• 1-3 years of claims, adjusting, or billing experience preferred
• Experience with Medicare reimbursement rules and CMS-1500 & UB-04 claims preferred
• Ability to work independently and exercise judgment