Medical Claims Analyst Jobs

Medical Claims Processor

The Medical Claims Processor is responsible for accurate and prompt payment of claims, in addition to reporting of statistics/data. Processors are responsible for adjudication of all claims, handling customer service calls as needed and recalculating claims as needed.

Primary Responsibilities:

· Review claims for financial responsibility including determining coordination of benefits

· Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization

· Adjudicate claims appropriately per contract or standard processing guidelines which includes appropriate coding of CPT and ICD codes against charges that are being billed and entered

· Maintain prompt turnaround time on all claims and handle priority claims within 24 hours

· Handle all customer service audits and quality assurance errors/opportunities within 48 hours

· Coordinate with the Claims Manager and/or Claims Supervisor on workflow issues and the handling of batches in date order

· Must meet and maintain 95% quality expectations; these are identified via errors tracked on phone calls, overpayments, unsolicited checks, appeals, TDI complaints and errors on processing by Audit Department

· Create and generate any overpayment documentation (notes in system, written communications) on all overpayments created by an analyst or any overpayments identified by analyst

· Must meet and maintain 30 claims per hour on production

· Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction

· Performs all other related duties as assigned

Required Qualifications:

· High School Diploma or GED

· 2+ years of medical claims processing experience

· Medical terminology, 10-key and computer literacy skills

· Proficient with Medicare processing guidelines, working knowledge of medical contracts, RBRVS, facility and ambulatory payment methodologies

· Exceptional ability to organize, prioritize and communicate effectively

· Must have commonly-used knowledge of claims examination concepts, practices and rules

· This position utilizes experience and judgment to plan, accomplish goals and effectively solve problems

We recognize that talented people are attracted to companies that provide competitive pay, comprehensive benefit packages, and outstanding advancement opportunities. For this reason, we offer a comprehensive benefits plan including the following:

· Competitive overall compensation package

· Career enhancement and growth opportunities

· 401(k) match up to 50% contribution

· Medical, dental, and vision coverage

· Life/AD&D insurance

· Accident/critical illness insurance

· FSA and HSA accounts

· Competitive paid time off

· Professional development/tuition funds

· Continuing education and career certification

· Company funded Lifestyle Spending Account

· Employee engagement activities

· Service recognition compensation

· Work/life resources

FCE is an equal opportunity employer.