Current jobs related to Hospital Claims Analyst - Springfield - Effingham Hospital Inc.

  • Claim Analyst

    3 weeks ago

    Springfield, United States Ally Full time

    General information Ref # 18466 Remote? No Ally and Your Career * Ally Financial only succeeds when its people do - and that’s more than some cliché people put on job postings. We live this stuff! We see our people as, well, people - with interests, families, friends, dreams, and causes that are all important to them. Our focus is on the health and...

  • Government Claims Trainer

    3 weeks ago

    Springfield, United States PacificSource Full time

    Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status,...

  • Healthcare Claims Denials Specialist

    4 weeks ago

    Springfield, Illinois, United States CenterWell Home Health Full time

    About the RoleWe are seeking a skilled Healthcare Claims Denials Specialist to join our team at CenterWell Home Health. As a key member of our operations team, you will play a critical role in ensuring the timely and accurate processing of healthcare claims.Key ResponsibilitiesCoordinate claim activities and designated agencies to ensure timely reimbursement...

  • Epic Systems Analyst

    4 days ago

    Springfield, Illinois, United States Hospital Sisters Health System Full time

    About the RoleWe are seeking a skilled Epic Systems Analyst to join our team at Hospital Sisters Health System. As an Epic Systems Analyst, you will assist in the gathering and analyzing of data, development, support, and functionality roll out of Epic and other supporting IT systems.Assists local ministries in optimizing their workflow processes through...

  • Business System Analyst-Guidewire

    2 months ago

    Springfield, United States Horace Mann Full time

    Title: Business Systems AnalystLocation: Springfield, IL or Addison, TX -Hybrid or remoteCompany: Horace MannEmployment Type: Full Time Horace Mann is a purpose-driven company that is passionate about educators. The Business Systems Analyst carries out procedures to ensure that all information technology solutions and services meet company standards and user...

  • Business Analyst

    1 week ago

    Springfield, United States Rose International Full time

    Date Posted: 10/17/2024Hiring Organization: Rose InternationalPosition Number: 472983Job Title: Business AnalystJob Location: Springfield, MA, USA, 01111Work Model: HybridEmployment Type: TemporaryEstimated Duration (In months): 6Min Hourly Rate($): 60.00Max Hourly Rate($): 65.00Must Have Skills/Attributes: Business Analysis, Data Mapping, Documentation,...

  • Data and Reporting Analyst

    6 days ago

    Springfield, Illinois, United States Public Consulting Group Full time

    Job Title: Sr Data and Reporting AnalystPublic Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Our team is committed to delivering solutions that change lives for the better.Key Responsibilities:Oversee the...

  • Revenue Integrity Analyst

    1 month ago

    Springfield, United States Baystate Health Full time

    Summary Description: The Revenue Integrity Analyst will report the the Director, Revenue Integrity and Advisory Services. They will ensures consistent charge capture and billing to promote optimal reimbursement by applying appropriate management of the Charge Error Worklist (CEWL), Correct Code Initiative (CCI) edits and Soarian billing edits in a timely...

  • Epic Systems Analyst

    3 weeks ago

    Springfield, Illinois, United States Inova Health System Full time

    About the RoleThe Sr. Epic Certified Systems Analyst - Radiant/Cupid is a key member of our team, responsible for implementing and maintaining EpicCare systems and databases to ensure optimal performance. This role requires a strong understanding of EpicCare and the ability to analyze complex IT projects to provide automated solutions that meet Inova Health...

  • Quality & Data Analyst Registered Nurse - Hospital/Critical Care

    2 weeks ago

    Springfield, United States Springfield Clinic Full time

    The Quality & Data Analyst RN is responsible for coordinating the care of quality improvement processes for the care of patients. Lead a multidisciplinary team as an advocate to observe and report care throughout internal and external systems, track that care and report outcomes and possible interventions. Responsible for serving as a patient advocate and...

  • Board Certified Behavior Analyst

    5 days ago

    Springfield, Virginia, United States Ally Behavior Centers Full time

    Job Title: Board Certified Behavior AnalystAlly Behavior Centers is seeking a highly skilled and dedicated Board Certified Behavior Analyst to join our team. As a key member of our clinical staff, you will be responsible for providing leadership and organizational management in client programming, behavior interventions, staff development, classroom...

  • IT Systems Analyst

    5 days ago

    Springfield, Illinois, United States CoxHealth Full time

    About the RoleThe IT Systems Analyst will be responsible for developing, testing, and maintaining applications and related information technologies. This role will also provide consulting services on integrating information technologies into clinical and business processes.Key ResponsibilitiesDevelop, test, and maintain applications and related information...

  • System Manager-Epic Radiant Lumens

    5 days ago

    Springfield, Illinois, United States Hospital Sisters Health System Full time

    About the RoleThe System Manager–Epic Radiant, Lumens & Imaging Applications is a critical position within Hospital Sisters Health System, responsible for managing, supporting, and implementing Epic applications (Radiant, Lumens), cardiology imaging applications, and Imaging applications for radiology systems.This role oversees departmental systems...

  • Customer Relationship Management Analyst

    4 weeks ago

    Springfield, Illinois, United States Lucky Lincoln Gaming, LLC Full time

    Job Title: Customer Relationship Management AnalystLucky Lincoln Gaming, LLC is seeking a skilled Customer Relationship Management Analyst to join our team. As a CRM Analyst, you will play a crucial role in interpreting data, analyzing results, and providing actionable insights to support decision-making across various departments.Key Responsibilities:Data...

  • Source Strategies Analyst

    1 month ago

    Springfield, United States USAJobs Full time

    DutiesRequirementsConditions of Employment Security Investigation SPECIAL INFO:As a condition of employment at NGA, persons being considered for employment must meet NGA fitness for employment standards. - U.S. Citizenship Required- Security Clearance (Top Secret/Sensitive Compartmented Information)- Polygraph Test Required- Position Subject to Drug...

  • Authorization Specialist

    4 weeks ago

    Springfield, Pennsylvania, United States Trinity Health Full time

    Job SummaryWe are seeking a highly skilled Authorization Specialist to join our team at Trinity Health. As an Authorization Specialist, you will be responsible for processing all THAH authorization documentation, ensuring compliance with HCFA/MCC/JCAHO regulations and guidelines.Key ResponsibilitiesProcess all frontend documentation needed to meet...

  • System Manager-Epic Radiant, Lumens

    3 weeks ago

    Springfield, Illinois, United States Hospital Sisters Health System Full time

    Job SummaryThe System Manager–Epic Radiant, Lumens & Imaging Applications is responsible for managing, supporting, and implementing Epic applications (Radiant, Lumens), cardiology imaging applications, and Imaging applications for radiology systems (including cardiovascular imaging) for Hospital Sisters Health System. This position oversees departmental...

  • Payment Policy and Reimbursement Specialist

    4 weeks ago

    Springfield, Massachusetts, United States Health New England Full time

    Job SummaryWe are seeking a highly skilled Payment Policy and Reimbursement Analyst to join our team at Health New England. This role is responsible for ensuring the accuracy and integrity of claim payments, as well as developing and maintaining payment policies and procedures.Key ResponsibilitiesDevelop and maintain payment policies and procedures to ensure...

  • System Manager-Epic Radiant, Lumens

    2 weeks ago

    Springfield, Illinois, United States Hospital Sisters Health System Full time

    About the RoleThe System Manager–Epic Radiant, Lumens & Imaging Applications is a critical position within Hospital Sisters Health System, responsible for managing, supporting, and implementing Epic applications (Radiant, Lumens), cardiology imaging applications, and Imaging applications for radiology systems (including cardiovascular imaging).Key...

  • IT Systems Analyst

    3 months ago

    Springfield, United States CoxHealth Full time

    Summary Best in Class Work Environment5x Modern Healthcare Best Places to workAmerica’s Greatest Workplaces 2023 – NewsweekBest Employers for New Grads 2023- ForbesGreatest Workplace for Women 2023 - Newsweek Benefits Robust, fully customizable benefits package including Medical/Vision/Dental and more!No cost eCare visitsEmployer-provided mental health...

Hospital Claims Analyst

4 months ago

Springfield, United States Effingham Hospital Inc. Full time
Job DescriptionJob DescriptionDescription:

JOB SUMMARY

Under the general direction of the Director of Business Services, the Hospital Claims Analyst will perform accurate/timely filing of initial insurance claims and secondary claims, follow up of claims not paid to assure payment to hospital and/or affiliated entities to maintain adequate cash flow and accounts receivable balance, in accordance with TJC, federal, state, and local guidelines, organizational and departmental policies and procedures. Communicates with medical staff, other departments, and outside agencies while maintaining confidentiality. Position requires self-motivation, creativity, and capabilities to function in a semi-autonomous role within a fast pace and dynamic environment.


STANDARDS OF PERFORMANCE

  1. Processes and adjust inpatient and outpatient medical claims in a timely fashion according to departmental quality and production standards.
  2. Assists Director of Business Services in researching and determining status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions.
  3. Performs follow up and takes necessary actions required to resolve all errors and findings assessed by Internal Audit and performance improvement plans.
  4. Ensures the validity of claims by reviewing files and attached documentation for completeness and accuracy.
  5. Identifies patterns in resubmitted and adjusted claims. Identifies errors, trends, and inconsistencies that require revisions to claim guidelines or system modifications.
  6. Documents systemic root cause analysis and recommend solutions to Director of Business Services.
  7. Resolves claims issues received by researching claim situations and provide timely reports and responses.
  8. Enhances department productivity by recommending improvements to workflow processes and organizational structure.
  9. Ensures the completeness and accuracy of Standard Operating Procedures by providing feedback to the department director on procedures that require documentation or additional detail.
  10. Contributes to the team effort by accomplishing the related goals and results as determined by the Insurance and Billing Department leadership team.
  11. Maintains documentation to support avoidance to negative financial, regulatory, and operational impact.
  12. Researches and responds to inquiries from various departments.
  13. Provide detailed reporting on claims volume, billed charges, savings, etc.
  14. Increase subrogation recovery efforts on approved claims.
  15. Assist in gathering customer feedback, defining processes, and identifying best practices.
  16. Handles PHI and maintains member privacy in accordance with HIPAA standards at all levels.
  17. Exhibits proficiency in all realms of insurance billing, including but not limited to managed care and commercial.
  18. Exhibits a thorough knowledge of hospital billing formats. Specifically, UB 04’s, 1500’s and contract billing.
  19. Review every account on ATB for insurance financial class and review and resolve auto rejected claims. Exception will be Medicaid and Medicare which should be forwarded to Business Services, Medicaid/Medicare primary A/R Analyst. Secondary A/R’s should be forwarded to the Business Services, Secondary insurance, primary A/R Analyst.
  20. Add insurance information into system and set to bill.
  21. Review all credit balance accounts and process patient refunds.
  22. Review all accounts on ATB for correct contractual and non-covered services.
  23. Review all accounts on ATB to identify master accounts and test accounts.
  24. Review all accounts on PP/ATB regarding denials due to lack of patient response.
  25. Review all accounts on ATB and identify and write up any adjustments such as employee discount, pp discounts. Etc., and forward for bad debt processing.
  26. Assist in answering phone calls and walk-ins.
  27. Must participate in continuing education and training to maintain and improve knowledge and skills as related professional skillset and the patient population EHS serves.
  28. Ensure proper infection control, OSHA and safety standards.
  29. Exhibits proficiency in all realms of insurance billing, including but not limited to managed care and commercial.
  30. Exhibits a thorough knowledge of hospital billing formats. Specifically, UB 04’s, 1500’s and contract billing.
  31. Other duties as requested, required, or assigned within scope of job and training.



Requirements:

Minimum Level of Education: Education level equivalent to completion of high school diploma.

Formal Training: claims experience skills including investigation, resolution and operations. Skill and experience in planning, organizing, implementing, facilitating, verbal and written communications. Must possess basic typing skills; have the ability to manage cash and give change; and use proper telephone etiquette.

Licensure, Certification, Registration: None required. Formal classes in Medical Office Procedure, and Medical Billing are preferred.

Work Experience: Two years billing/collection experience in the healthcare field. Intermediate computer skills with word processing and spreadsheet capabilities.

Computer Skills: Intermediate computer skills, including Microsoft Office Suite (Word, PowerPoint, and Excel); scheduling appointments/updating calendars