Healthcare Claim Analyst

 

This position reports to the Manager, Audits and Contracts and is responsible for analyzing hospital claims payment calculations to identify incorrectly paid claims based on specific managed care contracts using our proprietary software.

 

 

Qualifications

? Minimum of 3-5 years experience in health payer claims operations

? Full understanding of the managed care contract environment/interpretation of contract language

? Significant knowledge of DRG, ICD-9, revenue code, CPT coding methodologies

? Significant working knowledge of Excel, some database (Access, MS SQL Server etc) helpful

? Some working knowledge of APC?s and ASC?s helpful

 

Expectations

? Ability to analyze claim payment calculations results and to determine probable cause of error, based on the specific contractual provisions of the particular managed care contract

? Interact with client analysts in the discussion/resolution of audit results that are questioned by client

? Excellent analytical, verbal, inter-personal communications skills

? Interact/support internal software developers to identify possible application errors, deficiencies and improvements.

 

 

Responsibilities

? Analyze claims payment calculations for assigned clients

? Determine probable root cause of claims errors

? Evaluate accuracy of electronic contract documentation

 

 

 

Other