Hybrid Claims Appeals & Reimbursement Analyst

Orthoillinois, a Division of Orthomidwest; Rockford (IL); Hybrid; USD 34,000 - 48,000; Full time

Job summary

OrthoIllinois, a Division of Orthomidwest, seeks a Claims Analyst in Rockford, IL for a hybrid role requiring onsite work. The job focuses on variance analysis, filing claim appeals, and follow-up for professional and facility claims.

The role supports the Central Business Office and Contract Manager, working with payer networks and internal teams to ensure accurate reimbursements. Prior claims adjudication experience preferred; MS Excel and Google Suite skills are essential for daily tasks.

Qualifications

• High School Diploma or GED.
• Minimum of two years' experience in medical claims adjudication.
• Working knowledge of Microsoft Excel and Google Suites.
• Knowledge of payer websites and reimbursement methodologies preferred.

Responsibilities

• Maintain contract database and update contracts as directed.
• Identify claim variances and file appeals to insurers.
• Obtain updated payer fee schedules.
• Monitor appeal status with payers.
• Interpret payer contracts and reimbursement methodologies.
• Research payer reimbursement policies.
• Complete bundle payment allocations.
• Collaborate with CBO departments.

Skills

Service orientation

Communication

Interpersonal skills

Accountability

Education

High School Diploma or GED

Tools

Microsoft Excel

Google Suites

Job description

OrthoIllinois, a Division of Orthomidwest, seeks a Claims Analyst in Rockford, IL for a hybrid role requiring onsite work. The job focuses on variance analysis, filing claim appeals, and follow-up for professional and facility claims.

The role supports the Central Business Office and Contract Manager, working with payer networks and internal teams to ensure accurate reimbursements. Prior claims adjudication experience preferred; MS Excel and Google Suite skills are essential for daily tasks.