Claims Analyst

APS Health Care PR; San Juan (PR); In loco; USD 40.000 - 52.000; Tempo pieno

Descrizione del lavoro

APS Health Care PR is seeking a Claims Analyst in San Juan, PR. The role focuses on processing claims in line with policies, ensuring accuracy, and supporting audits and training as needed.

The candidate should have a High School diploma, data entry experience, and proficiency in MS Office tools such as Excel, Word, and PowerPoint.

Competenze

• High School diploma required.
• 1+ year of experience in data entry or similar roles.
• Knowledge of Microsoft Office including Excel, Word and PowerPoint.

Mansioni

• Processes claims using data entry and adjudication; handles adjustments.
• Summarizes plan documents for assigned accounts.
• Identifies possible COB coverage when applicable.
• Follows claim guidelines to obtain information for processing; processes routine adjustments.
• Collaborates on claim audit processes including analysis, site visits, and documentation.
• Maintains quality and accuracy of financial and procedural aspects.
• Handles correspondence and supports new hire training as needed.
• Complies with CMS guidelines and other regulatory requirements.

Conoscenze

Data entry

Attention to detail

MS Excel

Communication

Formazione

High School diploma

Data entry-related degree preferred

Strumenti

Microsoft Office Suite

Excel

Word

PowerPoint

Descrizione del lavoro

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Claims Analyst

Claims Review & Audit Full Time Clerical San Juan, PR, US

2 days ago Requisition ID: 1522

Position Summary:

The Claims Analyst processes claims in accordance with established policies and procedures. This key individual incorporates and assures quality production principles in all areas of the Claims Department.

Essential Functions:

1. 1. Processes claims utilizing data entry and adjudication; executes claims’ adjustments when needed.
2. 2.Maintains a thorough knowledge of provider contractual issues and summarizes plan documents for each assigned accounts.
3. 3.Identifies possible coordination of benefits (COB) coverage if applicable.
4. 4.Follows claim processing guidelines to obtain all necessary information for accurate and timely processing. Processes routine claims adjustments either electronically or manually while maintaining daily productivity rating. Receives and validates claims from internal and external clients.
5. 5.Collaborates with duties related to the claim audit process, this includes but is not limited to claim analysis, site visits, document preparation and proper file storage.
6. 6.Maintains overall quality, accuracy of financial, and procedure aspects of operation.
7. 7.Receives and processes correspondence when needed.
8. 8.Collaborates with new hire training when needed.

Other Duties:

• Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
• In addition, all other duties assigned by the manager and/or supervisor.

Education:

• High School diploma.
• Degree in Data Entry or related preferred.

Experience:

• Minimum 1 year of experience in similar position or data entry.

Knowledge:

• Knowledge of Microsoft Office including Excel, Word and PowerPoint.