Senior Claims Analyst: Adjudication & Provider Liaison

University Health; San Antonio (TX); In loco; USD 45.000 - 60.000; Tempo pieno

Descrizione del lavoro

University Health in San Antonio seeks a claims analyst to review, analyze, and adjudicate all claim types, including coordination of benefits and DME, ensuring accurate processing and timely resolutions.

The role also analyzes provider appeals, documents outcomes in correspondence, and serves as a liaison to providers, leveraging corporate systems to resolve claim issues. Strong knowledge of medical coding and managed care principles is essential.

Competenze

• High school diploma or GED required with strong grasp of medical terminology.
• Minimum 5 years of HMO/PPO/ASO claim processing experience is required.
• Thorough knowledge of ICD-9/CPT4 Coding and managed care principles.

Mansioni

• Review, analysis, and adjudication of all claim types including coordination of benefits and DME claims.
• Analyze provider appeals and document outcome determinations via correspondence.
• Act as provider liaison for claim issue resolution using appropriate corporate functionalities.

Conoscenze

Claim processing

Provider liaison

Analytical thinking

Formazione

High school diploma or GED

Five years HMO, PPO, ASO claim processing experience

Strumenti

Medical coding ICD-9/CPT4

Descrizione del lavoro

University Health in San Antonio seeks a claims analyst to review, analyze, and adjudicate all claim types, including coordination of benefits and DME, ensuring accurate processing and timely resolutions.

The role also analyzes provider appeals, documents outcomes in correspondence, and serves as a liaison to providers, leveraging corporate systems to resolve claim issues. Strong knowledge of medical coding and managed care principles is essential.