Claims Analyst

Healthcare Support Staffing; Phoenix (AZ); Presencial; USD 45.000 - 65.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive salary

Medical, Dental, and Vision benefits

Positive work environment

Weekday schedule 8-5

Descripción de la vacante

A healthcare services provider is seeking a candidate for a role focused on validating disputes on financial claims. Responsibilities include accurate coding, generating appeals, and escalating denial trends. The ideal candidate has at least two years of experience in healthcare billing and collections, strong knowledge of payer processes, and excellent business writing skills. Benefits include competitive salary and a supportive work environment, with working hours from 8:00 AM to 5:00 PM, Monday to Friday.

Formación

• 2 years minimum in a Hospital or RCM environment performing billing / collections / disputes & claims research.
• Intermediate understanding of Explanation of Benefits form (EOB).
• Understanding of UB-04 / 1500 forms.

Responsabilidades

• Validate denial reasons and ensure coding is accurate.
• Generate appeals based on dispute reasons and contract terms.
• Escalate exhausted appeal efforts for resolution.
• Escalate exhausted appeal efforts for resolution
• Work payer projects as directed
• Research contract terms and compile supporting documentation for appeals
• Take corrective action and code the system accordingly
• Escalate denial or payment variance trends to NIC leadership

Conocimientos

Payer Knowledge

AR follow up Experience

Medical terminology

Advanced business letter writing skills

UB-04 / 1500

Medical terminology

Professional writing

Multitasking

Descripción del empleo

Conifer Health has been providing managed services to health systems, their health plans and managed populations for more than 30 years. Our value-based solutions enhance consumer engagement, drive clinical alignment, manage risk, and improve financial performance. Our purpose of providing the foundation for better health fuels our clients to meet the unique needs of the communities they serve.

Job Description

Summary:

Responsible for validating disputes presented on Explanation of Benefits (EOB), entering denied claim into the DMT database, and escalating payment/variance trends to Management and generating appeals for denied or underpaid claims.

Essential Functions:

• Validate denial reasons and ensures coding is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary
• Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.
• Follow specific payer guidelines for appeals submission
• Escalate exhausted appeal efforts for resolution
• Work payer projects as directed
• Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments.
• Perform research and makes determination of corrective actions and takes appropriate steps to code the system and route account appropriately.
• Escalate denial or payment variance trends to NIC leadership team for payor escalation.

Qualifications

• 2 years minimum in a Hospital or RCM environment performing billing / collections / disputes & claims research
• Payer Knowledge – MUST be strong in payer knowledge & being able to identify trends
• AR follow up Experience
• Intermediate understanding of Explanation of Benefits form (EOB).
• Understanding of UB-04 / 1500 forms
• Medical terminology
• Advanced business letter writing skills (Correct use of punctuation / grammar)
• Must be able to multi-task and adapt to change

Additional Information

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment
• Monday-Friday must be available from 8:00AM to 5:00PM hour shift.