Healthcare Claims Appeals Analyst

OrthoIllinois; Rockford (IL); On-site; USD 42,000 - 68,000; Full time

Job summary

OrthoIllinois in Rockford, IL, is seeking a Claims Analyst to perform variance analysis, identify underpayments, file appeals, and manage reconsiderations for professional and facility claims.

The role requires at least two years in medical claims adjudication, proficiency with Excel and Google Suites, and familiarity with payer websites and reimbursement rules. Office/clinic setting with standard business hours.

Qualifications

• Two years of experience in medical claims adjudication.
• Basic knowledge of payer websites and reimbursement methodologies.
• Working knowledge of Microsoft Excel and Google Suites.

Responsibilities

• Maintain contract database and update as directed by Contract Manager.
• Use software to identify claim variances and file appeals to insurance carriers for reimbursement.
• Obtain updated fee schedules from payers.
• Monitor appeal status with payers in a timely manner.
• Interpret payer contracts, especially reimbursement language and methodologies.
• Collaborate with departments in the Central Business Office.

Skills

Claims analysis

Variance analysis

Appeals handling

Education

High School Diploma or GED

Tools

Microsoft Excel

Google Suites

Job description

OrthoIllinois in Rockford, IL, is seeking a Claims Analyst to perform variance analysis, identify underpayments, file appeals, and manage reconsiderations for professional and facility claims.

The role requires at least two years in medical claims adjudication, proficiency with Excel and Google Suites, and familiarity with payer websites and reimbursement rules. Office/clinic setting with standard business hours.