Claims Analyst

APS Healthcare, Inc.; San Juan (PR); On-site; USD 35,000 - 55,000; Full time

Job summary

APS Healthcare, Inc. in San Juan, Puerto Rico is seeking a Claims Analyst to process claims in accordance with policies and ensure quality production in the Claims Department.

You will adjudicate claims, identify COB when applicable, maintain knowledge of provider contracts, support audits, and collaborate with training as needed. A high school diploma and 1 year in data entry or similar role are required; MS Office proficiency is expected.

Qualifications

• Requires a High School diploma; a data entry-related degree is preferred.
• Minimum 1 year of experience in a similar role or data entry.
• Knowledge of Microsoft Office including Excel, Word and PowerPoint.

Responsibilities

• Processes claims utilizing data entry and adjudication; executes claim adjustments when needed.
• Maintains knowledge of provider contractual issues and summarizes plan documents for each assigned account.
• Identifies possible COB coverage when applicable.
• Follows claim processing guidelines to obtain all necessary information for accurate processing and timely processing.
• Collaborates on the claim audit process, including analysis, site visits, document preparation and proper file storage.
• Maintains overall quality and accuracy of financial and procedural aspects of operations.
• Receives and processes correspondence as needed.
• Assists with new hire training when needed.

Skills

Data entry

Claims processing

Attention to detail

Education

High School diploma

Data Entry related degree preferred

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

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

5 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. Processes claims utilizing data entry and adjudication; executes claims’ adjustments when needed.
2.Maintains a thorough knowledge of provider contractual issues and summarizes plan documents for each assigned accounts.
3.Identifies possible coordination of benefits (COB) coverage if applicable.
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.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.Maintains overall quality, accuracy of financial, and procedure aspects of operation.
7.Receives and processes correspondence when needed.
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.