Claims Reporting Analyst

Position Summary:

The Claims Information Analyst will coordinate transfer of information from a centralized database to a distributing environment.  Analyze claims data, identify provider billing patterns or trends that could potentially be construed as fraudulent or abusive coding.

 

Essential Job Functions:

 

1.  Produce reports pulling data from a variety of sources and perform in-depth analysis on this data.  Evaluate provider, member and pharmacy claims data with emphasis on pattern recognition. 

 

2.  Communicate results of analysis effectively to all team members.

 

3.  Special projects as assigned.

 

Other Duties:

 

While this job description is intended to be an accurate reflection of the duties involved in this position, the company reserves the right to add, remove or alter duties when business need dictates.



 

Minimum Requirements:A bachelor?s degree in Accounting, Business, Finance or Computer studies required, 3-5 years prior experience in data analysis and/or reporting preferably in a HMO environment.  Demonstrated advanced knowledge and aptitude in MS Access, Excel, SQL, as well as Crystal Reports a plus.  Knowledge of ICD-9, CPT, HCPCS and DRG codes with familiarity of CMS reimbursement a plus.



 

Physical Demands:

 

The physical demands described below are representative of those that must be met by the employee to perform the essential functions of the job.  If requested, reasonable accommodation may be made to enable individuals with disabilities to perform essential job functions.

 

While performing the duties of this job the employee is regularly required to sit, stand, walk, talk, hear and see.  The employee must use both hands to feel and operate a computer keyboard.  The vision requirements include:  close vision, distance, vision, peripheral vision, depth perception and ability to focus.

 

 

HealthSpring offers a competitive salary and full range of benefits

For more information and to apply 

visit www.myhealthspring.com and complete an application.

All interested candidates must complete an on line application

Select Department:  Claims

Select Position: Claims Adjudicator Analyst (for application purposes only)

Attach Resume

No phone call accepted

HealthSpring USA, LLC is an EEO/AA employer.