Claims Research Analyst - 25-208
- Screen and research all claims to ensure the following:
- Claim contains pertinent and correct information for processing PDRs and adjustments.
- Accurate final claims adjudication by using on-line computer claims payment system. This includes research on previously processed claims when needed.
- Maintain 98% accuracy rate.
- Maintain 100% productivity goal.
- Utilize Epic to document PDRs/adjustments as needed.
- Develop a CRM and generate letters as appropriate.
- Complete special projects as assigned to meet department and company goals.
- Identify billing patterns, processing errors, and/or system issues that inhibit the final adjudication of claims.
- One year internal/external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO) or HP
- Working knowledge of CPT codes, ICD-10 codes, Revenue Codes and HCPC codes
- Medical terminology preferred
- Must type at least 40 WPM on a personal computer/keyboard
- Strong research, judgment, decision-making and problem-solving skills
- Ability to work independently or as a team
- Strong written- and verbal-communication skills including maintaining open lines of communication within all departments of the organization
- Ability to work in a fast- paced environment
- Ability to focus on repetitive claims sorting detailed information
- High School Diploma/GED required
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