Claims Analyst
Current• Function as a key member of the claims processing team, independently adjudicating complex medical claims while ensuring accuracy and compliance with healthcare regulations, company guidelines, and industry best practices. Utilize strong analytical and research skills to meticulously evaluate medical necessity, determine coverage based on intricate plan benefits and provider contracts, and identify potential fraud or abuse.• Effectively communicate with healthcare providers and patients to clarify information, resolve discrepancies, and obtain missing documentation in a timely and professional manner, fostering positive working relationships. This collaborative approach streamlines the claims processing workflow and ensures a positive experience for all parties involved.• Maintain a high level of accuracy and efficiency by leveraging data entry skills and proficiency in medical coding systems (ICD-10-CM, HCPCS Level II). These skills contribute to a streamlined claims processing workflow and ensure accurate reimbursement for covered services.• Actively contribute to a positive and collaborative team environment by readily sharing knowledge and expertise with colleagues, fostering a supportive and efficient work unit. This commitment to teamwork allows for continuous learning and professional development within the team.
