Hybrid Healthcare Claims Analyst II

Network Health; Menasha (WI); Hybrid; USD 52,000 - 70,000; Full time

Job summary

Network Health in Wisconsin seeks a Claims Analyst II to inspect and process professional and facility claims. You will determine whether to pay, pend, deny, or return claims per policies and procedures, while maintaining confidentiality and accuracy.

Responsibilities include adjudicating claims, verifying information, pursuing COB and subrogation issues, and ensuring timely processing. Familiarity with ACA/Medicaid and coding is preferred; hybrid work options available.

Qualifications

• High school diploma or equivalent preferred.
• 2-4 years claims processing experience required.
• Knowledge of CPT and ICD-9/ICD-10; COB processing and subrogation.
• Coding experience preferred.

Responsibilities

• Processes Professional and Facility claims for payment per policies.
• Reviews claims to ensure proper billing standards and complete information.
• Obtains additional information from appropriate person or agency as needed.
• Maintains department turnaround processing time and quality standards.
• Identifies COB, Workers' Compensation, and Subrogation issues and adjudicates.
• Investigates pending claims and resolves them within established timeframes.
• Documents attributes and memos related to claims payment.
• Processes specialty claims (transplant, URN, COB) per external contract.

Skills

Medical terminology

CPT/ICD knowledge

COB processing

Subrogation

Coding experience

Education

High school diploma or equivalent

Tools

WRAP re-pricing website

Job description

Network Health in Wisconsin seeks a Claims Analyst II to inspect and process professional and facility claims. You will determine whether to pay, pend, deny, or return claims per policies and procedures, while maintaining confidentiality and accuracy.

Responsibilities include adjudicating claims, verifying information, pursuing COB and subrogation issues, and ensuring timely processing. Familiarity with ACA/Medicaid and coding is preferred; hybrid work options available.