Global Claims Management Analyst

Jobtailor; Deutschland; Remote; EUR 45.000 - 65.000; Vollzeit

Zusammenfassung

Jobtailor is seeking an experienced claims professional to oversee medical insurance billing, claims management and revenue cycle processes for domestic and international lines. You will audit claims, manage payer collections, and support contract management and process improvements.

The role requires strong administrative and communication skills, with the ability to work independently and prioritize in a fast-paced environment.

Qualifikationen

• Associate degree required.
• Minimum 5 years of experience.
• Strong background in medical insurance billing, collections, coding, and revenue cycle.

Aufgaben

• Execute all Claims Management and Third Party Administrative (TPA) functions for system-wide Domestic and International lines of business.
• Accurately audit and analyze medical claims.
• Manage timely payer collections and claim adjudication.
• Maintain, develop and administer the PNS Contract Management Process.
• Back up Team Lead(s) for Para-Claim Parathon solution management.
• Analyze claim data to identify anomalies, trends and discrepancies.
• Manage the physician claims appeal and reimbursement reconsideration process for all lines of business.
• Support Team Lead(s) and leadership in departmental process improvement initiatives.
• Support department leaders and Team Lead during payment and reconciliation processes as needed.

Kenntnisse

Medical Insurance Billing

Claims Management

Revenue Cycle

Contract Management

HIPAA Regulations

Ausbildung

Associate Degree

Tools

JDA ACO

Web Tool Parathon

EPSi

Soarian Financials

Cerner Power Chart

MS Power BI

Jobbeschreibung

• Execute all Claims Management and Third Party Administrative (TPA) functions for system-wide Domestic and International lines of business
• Accurately audit and analyze medical claims
• Manage timely payer collections and claim adjudication
• Maintain, develop and administer the PNS Contract Management Process
• Back up Team Lead(s) for Para-Claim Parathon solution management
• Analyze claim data to identify anomalies, trends and discrepancies
• Manage the physician claims appeal and reimbursement reconsideration process for all lines of business
• Support Team Lead(s) and leadership in departmental process improvement initiatives
• Support department leaders and Team Lead during payment and reconciliation processes as needed

Requirements

• Associate degree
• 5 years of experience
• Strong background in Medical Insurance Billing and collections, coding, claims regulations, revenue cycle, provider contract management, operational support and registration
• Solid understanding of hospital operations, contractual analysis, FDA health regulations, HIPPA regulations, DRG guidelines
• Exceptional administrative skills
• Thorough understanding of all required fields on a 1500 and/or UB for hospitals, diagnostic facilities and physician practices
• Excellent written and verbal communication skills
• Superb customer service skills
• Ability to work independently, demonstrate a high level of initiative, prioritize deadlines and make decisions
• Results driven, with a desire to work in a fast-paced environment that values collaboration, integrity and customer focus
• Experience preferred with JDA ACO, Web Tool Parathon, EPSi, Soarian Financials, Cerner Power Chart, Business Objectives Enterprise, MS Power BI, Pro Diver or other payer modeling

Core Competencies

Demonstrates expertise in Medical Insurance Billing, Claims Management, and Revenue Cycle processes, with a strong focus on operational support and compliance with health regulations. Proven ability to analyze claim data and manage appeals while supporting departmental initiatives and improving processes.

Highest-signal resume keywords

• Medical Insurance Billing
• Claims Management
• Revenue Cycle
• Contract Management
• HIPAA Regulations

ATS Optimization Keywords

Hard Skills

• Claims Auditing
• Claims Analysis
• Payer Collections
• Coding Regulations
• 1500 and UB Forms Proficiency

Soft Skills

• Exceptional Administrative Skills
• Excellent Communication Skills
• Superb Customer Service Skills
• Independent Decision-Making
• Results Driven

Certifications & Qualifications

• Associate Degree

Industry Keywords

• Claims Regulations
• Operational Support
• Contractual Analysis
• FDA Health Regulations
• DRG Guidelines

Tools & Technologies

• JDA ACO
• Web Tool Parathon
• EPSi
• Soarian Financials
• Cerner Power Chart
• MS Power BI