5.240_PB Confluence_Medical Claims Analyst at Med-Metrix

Chennai, tamil nadu, India -

Full Time

Start Date

Immediate

Expiry Date

15 Mar, 26

Salary

0.0

Posted On

15 Dec, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Claims Analysis, Account Follow Up, Billing, Collections, Payer Communication, Problem Solving, Analytical Skills, Medical Billing, Denials Management, Appeals Process, Interpersonal Skills, Confidentiality, HIPAA Compliance, Customer Service, Attention to Detail, Time Management

Industry

Hospitals and Health Care

Description

Job Purpose The Medical Claims Analyst is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them. Duties and Responsibilities Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites Meets and maintains daily productivity/quality standards established in departmental policies Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts Adheres to the policies and procedures established for the client/team Knowledge of timely filing deadlines for each designated payer Performs research regarding payer specific billing guidelines as needed Ability to analyze, identify and resolve issues causing payer payment delays Ability to analyze, identify and trend claims issues to proactively reduce denials Communicates to management any issues and/or trends identified Initiate appeals when necessary Ability to identify and correct medical billing errors Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process Understanding of under or over payments and credit balance processes Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required Act cooperatively and courteously with patients, visitors, co-workers, management and clients Work independently from assigned work queues Maintain confidentiality at all times Maintain a professional attitude Other duties as assigned by the management team Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications Completed at least High School education Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers) Experienced on medical billing/ AR Collections Background in calling insurance (Payer) to verify claim status and payment dispute Strong interpersonal skills, ability to communicate well at all levels of the organization Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses High level of integrity and dependability with a strong sense of urgency and results oriented Excellent written and verbal communication skills required Gracious and welcoming personality for customer service interaction Working Conditions Must be amenable to work night shifts Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment: The noise level in the work environment is usually minimal. Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Responsibilities

The Medical Claims Analyst is responsible for collections, account follow-up, billing, and allowance posting for assigned accounts. They must ensure timely resolution of outstanding claims and adhere to departmental policies and procedures.