Hybrid Executive - Claims Analyst - Repricing and Extended Functions

Posted last week

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About the role

  • Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
  • Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
  • Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
  • Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
  • Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
  • Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
  • Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
  • Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
  • Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.

Requirements

  • Any Graduate/Postgraduate
  • 1-3 years of Experience
  • Good communication, flexibility, reliability
  • Knowledge in Microsoft Outlook/Excel/Word/PPT
  • Strong Analytical skills with the ability to investigate and resolve issues
  • Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.

Benefits

  • Complete the necessary training and meet the expectations outlined for the position.
  • Follow all standard operating procedures (SOP) diligently.
  • Complete audits promptly and ensure high quality.
  • Strive to meet both quality and production targets.
  • Adhere to project protocols and instructions.
  • Report any issues or trends promptly.
  • Maintain the logs (such as productivity, clarification, and others as applicable) updated.
  • Seek clarification from the manager or team leader when needed.
  • Promptly respond to all emails from the manager.
  • Ensure compliance with all relevant regulations and policies.

Job title

Executive - Claims Analyst - Repricing and Extended Functions

Job type

Experience level

Junior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

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