Covington, Kentucky
Hospital Claims Analyst Job Opening in Covington, Kentucky - Position Summary: Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client.
Essential Duties and Responsibilities:
Build strong, lasting relationships with clients, payors and BLS personnel
Review insurance contracts to gain thorough understanding of payment methodologies
Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting
Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other BLS personnel
Support and direct claims to all BLS departments and client onsite analysts
Attend client, department and company meetings
Comply with federal and state laws, company and department policies and procedures
Essential Skills and Experience:
Minimum 2-years experience working in an operational setting, preferably managed care or hospital patient accounts
High School diploma or equivalent
Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
Experience working with ICD-9, CPT-4 and/or HCPCS coding systems
Knowledge of insurance submittal procedures and medial forms (including UB04 and CMS1500)
Experience performing account resolution with third party payors
Accounts receivable collections from payors (no self pay)
Ability to effectively identify and communicate payor trends
Organization and documentation skills to ensure timely follow-up and accurate record keeping
Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
Ability to present written routine correspondence (in English)
Ability to present ideas on complex, detailed issues with ease
Ability to define problems, collect data, establish facts and draw valid conclusions
Strong customer service orientation
Excellent interpersonal and communication skills
Strong team player
Commitment to company values
Non-Essential Skills and Experience:
Related Professional (s)
Associate or Bachelor's Degree(s)
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
: 2 years
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