Madison, Wisconsin
Claims Analyst Job Opening in Madison, Wisconsin - The Claims Analyst reviews and analyzes claims for accuracy, completeness and eligibility. The Claims Analyst is familiar with standard concepts, practices, and procedures within the operational unit. This position prepares and maintains reports and records for processing. This position is responsible for providing detailed claim information and assisting the management team with monitoring, controlling, planning, and accomplishing claims processing goals. This position performs a variety of tasks, works under general supervision, and reports to the Claims Manager.
Essential Functions and Responsibilities
Participating in meetings to address the resolution of client, provider and internal problems and issues
Collaborating with clients and other PPI staff to ensure that organizational goals are met in terms of performance standards, efficiency and accuracy of processes and the organizations goals
Maintain adherence to company policies and procedures regarding confidentiality and HIPPA compliance
Investigate operational issues, develop, propose and execute corrective actions
Analyze and report historical data and trends
Distribute weekly and daily staffing review meetings with management and intraday analysts detailing previous and current week?s performance and forecasted performance of remainder of current week and next week, while also identifying risks
Generate new forecast when current day forecast has high deviation from actual
Work closely with the Manager of Operations to develop, conduct and analyze audit methods and reporting of claims and customer service operations
Perform other duties and assignments as directed
Required Qualifications
Bachelor?s Degree, preferred. In lieu of degree, 3+ years of professional experience in reviewing and monitoring claims experience in a claims operations
Certified Professional Coder/AAPC preferred (or must be complete within 6 months of hire)
3+ years Claims Coding or auditing experience
ICD-10 Proficient
Strong understanding of CMS-1500 and UB-04 Medical Claims forms
Assist with testing and upgrades
Develop and implement quality improvement strategies
Subject matter expert for all areas of the company and may be assigned special projects.
Five years of experience in a leadership role in a health insurance claims processing operation
Experience in the development and implementation of claims processing systems
Strong mathematical, analytical, communication, and organization skills
Natural curiosity, persistence and the ability to conduct detailed research are useful when verifying claims
Personal computer skills and the ability to learn new computer applications
Advanced knowledge of Excel (i.e. data sorting, filtering, pivot tables, etc.)
Knowledge of health care standards appropriate to specific claim
Knowledge of medical, pharmaceutical, and other health services, practices, and terminology
Knowledge of medical reimbursement policies, procedures and standards
Knowledge of health care billing standards and procedures
Knowledge of data analysis methods
Ability to gather, manage and synthesize large amounts of information efficiently, effectively and creatively
Ability to analyze health services utilization data
Ability to analyze and resolve health services claims and related problems
Ability to maintain records, and prepare reports and correspondence related to the work
Ability to maintain confidentiality of information
Strong interpersonal skills with the ability to build and maintain productive working relationships with others and contribute as an effective team member.
Job Type: Full-time
Required experience:
claims coding or auditing: 3 years
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