Claims Analyst I

JOB TITLE:   Claims Analyst

SUMMARY:

This position is responsible for assisting with following up on administrative appeals and documentation submitted to health insurers and governmental payers; working well with attorneys and paralegals; maintaining the workload.

DUTIES AND RESPONSIBILITIES:

• Works within the client’s Patient Accounting system, payer portals and/or websites, and will utilize proprietary software to research accounts in the work queue.
• Determines action required to resolve the underpayment and initiate that action, including submitting appeals and reconsideration requests.
• Utilizes increased knowledge of the industry, hospital revenue cycle, and payers/insurance companies to document the account and provide information and details to support paralegal’s/attorney’s pursuit for additional reimbursement
• Quickly and efficiently prepares, reviews, and submits well-written claims correspondence and related documents to insurers
• Is skilled, aggressive, cordial, and professional on the telephone to follow up on submitted appeals.
• Performs other related duties as assigned by management.

QUALIFICATIONS:

• Bachelor's Degree (BA/BS) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.
• Other skills required: 
  1. BA/BS with a GPA of 3.0 or higher.
  2. Interest in healthcare and healthcare law.
  3. Able to navigate through various computer systems and applications to find information about insurance claims.
  4. Ability to prioritize and multi-task.
  5. Excellent written and verbal communication skills.
  6. Proficiency in Microsoft Office, including Word and Excel.
  7. Excellent organizational and time management skills.
  8. High attention to detail.
  9. Clear, concise, and logical writing style.

COMPETENCIES:

• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
• Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.
• Business Necessity – The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• External Working Relationships – Develops and maintains courteous and effective working relationships with clients, vendors and/or any other representatives of external organizations.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.