Claims Analyst

Responsibilities

The Claims Analyst will perform claims analysis for claims submitted from the existing billing system to Clearinghouse. Reviews billing system tables and outbound claim files to the clearinghouse to determine issues for impact and resolution. Works with Revenue Cycle management team to trend issues, suggest issue resolution, implement solutions.

• Maintains Clearinghouse administration functions to add users and create groups. Completes user administration control records.
• Produces weekly synopsis of accomplishments and identifies goals or ongoing projects each week and presents to management.
• Reviews rejected claims for trends and analysis at an enterprise level, familiar with all aspects of claims cycle.
• Creates clear documentation on current processes and presents documentation to management.
• Assists in training users on Clearinghouse processes and has familiarity with the Clearinghouse processes.
• Monitors claims and charges life cycle and associated lists to identify issues or problems and notifies the appropriate manager.
• Accesses claim ticketing process for Clearinghouse requests and reviews and triages of tickets for claims research or other requests for Clearinghouse functions.
• Performs claims audit processes and files to match claim files and claim numbers sent from the billing system and received at the Clearinghouse to prepare for internal audit requests.
• Takes training on Clearinghouse and billing systems available online for functionality and obtains required certification for Clearinghouse or billing system functionality.
• Attends meetings on location implementation, new Clearinghouse review and testing.
• Assists with system claims testing and review.
• Reviews claims mapping to maintain consistent mapping information and electronic claims submission.
• Maintains security, integrity and business continuity controls and documents.
• Provides excellent customer service to all Practices. Maintains user confidence and protects operations by keeping information confidential.

PLEASE NOTE: This is not an exhaustive list of all duties, responsibilities and requirements of the position described above. Other functions may be assigned and management retains the right to add or change duties at any time.

• Ability to interact with customers and to document customer needs.
• Works with all levels of management and communicates concisely.
• Knowledge of claims processes and terminology, code sets including Procedure codes, Diagnostic codes, and Modifiers.
• Imaging Billing Experience a plus.
• Strong communication skills and demonstrates ability to work with business to resolve claims issues.
• Two plus years of Healthcare experience.
• Proficient in Office products Excel, Word, Visio.
• Microsoft Access a plus.

Quality Standards

• Communicates, cooperates, and consistently functions professionally and harmoniously with all levels of supervision, co-workers, patients, visitors, and vendors.
• Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
• Attends regular corporate meetings as requested.
• Follows OSHA regulations, RadNet and site protocols, policies and procedures.
• Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.
• Practices universal safety precautions.
• Promotes good public relations on the phone and in person.
• Adapts and applies new tasks, methods, and systems.
• Reports to work regularly as scheduled; consistently punctual with respect to working hours and lunch schedules, and maintains satisfactory personal attendance in accordance with RadNet guidelines.
• Completes job responsibilities in a quality and timely manner.