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

Completed at least High School education
Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)
Experienced on medical billing/ AR Collections
Background in calling insurance (Payer) to verify claim status and payment dispute
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required
Gracious and welcoming personality for customer service interaction

Working Conditions

Must be amenable to work night shifts
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
Work Environment: The noise level in the work environment is usually minimal.

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.

EVERGREEN - Medical Claims Analyst