Claims Analyst at J Arthur Dosher Memorial Hospital

Southport, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Jul, 26

Salary

0.0

Posted On

07 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims processing, Medical billing, Contract management, Data analysis, Microsoft Excel, Medical terminology, CPT-4, ICD-10, HIPAA compliance, Insurance policy interpretation, Fraud detection, Reporting metrics, Reimbursement analysis

Industry

Medical Practices

Description

Description Full-Time (40 hours) Responsible for reviewing and investigating healthcare insurance claims to determine appropriate contractual payments and adjustments, validity and accuracy Functions of the Position (not an exhaustive list): Investigate claims: Research and evaluate claims for legitimacy and accuracy, which may involve gathering additional information from other parties including payers, providers and other departments Contract Management Platform: Use and maintenance of existing contract management software, including uploading, maintaining and removal of payer contracts. Reporting: Maintaining, analyzing and providing reporting metrics related to payer reimbursement data in a timely and predictable manner Process claims: Analyze insurance claims according to policy provisions and guidelines Determine eligibility: Interpret complex policy language and provisions to determine coverage and appropriate reimbursement amounts Detect fraud: Analyze claim data and identify irregularities or patterns that may indicate fraudulent activity Requirements Qualification 1. Education: High School diploma or equivalent Hospital billing experience preferred 2. Physical Demands: Requires sitting for long periods; sometimes in a confined space Lifting/carry up to 20lbs Repetitive finger movement Manual dexterity and mobility Reaching at all levels Stooping, bending, kneeling, crouching Work with machinery with moving parts 3. Experience: Previous experience in claims processing or medical billing preferred Knowledge of policies and regulations: Strong understanding of insurance policies, coverage limitations, and industry-specific regulations (e.g., HIPAA for health claims) Claims management software: Proficiency with claims processing and management software Data analysis: Ability to collect, analyze, and interpret claims data using tools like Microsoft Excel and other databases Medical terminology: Familiarity with medical codes (CPT-4 and ICD-10) for health claims and basic legal principles.

Responsibilities

The Claims Analyst is responsible for investigating and processing healthcare insurance claims to ensure accurate contractual payments and adjustments. They also manage payer contracts and provide reporting metrics related to reimbursement data.