As a Medical Claims Analyst, you will be responsible for reviewing, analyzing, and interpreting medical information to assess and determine the appropriate actions for claims processing. This role is crucial in ensuring that claims are handled efficiently and effectively, which may result in either denial or payment. You will work under general supervision according to established guidelines, with a focus on promoting customer capabilities by creating a self-service enabled platform tailored to core customers' needs.
Essential Functions
- Review and analyze discrepancies in claims by cross-verifying data from various sources.
- Demonstrate familiarity with the U.S. healthcare domain and regulations, including HIPAA compliance.
- Utilize a deep understanding of medical coding, billing practices, and medical terminologies.
- Exhibit strong attention to detail and analytical skills for processing complex medical documentation.
- Apply critical thinking and independent decision-making skills to resolve issues effectively.
- Navigate healthcare information systems with proficiency, ensuring accuracy in claims processing.
- Operate with urgency in a real-time service environment to meet performance expectations.
- Collaborate with team members to achieve individual and collective goals.
- Define, communicate, and manage workflow and data coordination to support implementation-related reports, including inventory, capacity reporting, and ad-hoc reports as needed by management.
- Perform other duties as assigned.
Performance Parameters
- Productivity. Ensure efficient processing of claims.
- Quality. Maintain high standards of accuracy in work.
- Turnaround Time. Meet assigned deadlines for claim processing.
- Attendance & Schedule Adherence. Follow attendance policies and schedules.
Primary Internal Interactions
- Subject Matter Experts (SME), Assistant Managers (AM), and Line Managers (LAM). Collaborate on performance reporting, escalation handling, and clarifying concerns.
- Quality Control Analysts (QCA). Provide and receive feedback on associate performance and audit processes to enhance training curriculum.
- Mentors. Seek clarification and support in real-time for process-related queries and challenges.
Qualifications
- Bachelor's degree in a relevant field or equivalent experience in the healthcare industry.
- Proven experience in medical claims processing or related roles.
- Strong analytical skills and attention to detail.
- Excellent communication and interpersonal skills.
- Proficiency in healthcare information systems and applications.
Why Join Us?
This is an opportunity to be part of a dynamic team in the healthcare sector, where your contributions will directly impact the efficiency of claims processing and the quality of service provided to our customers. If you are detail-oriented, analytical, and passionate about healthcare, we invite you to apply and join us in making a difference.