Claims Analyst

**Job description**

**Healthcare Claims Analyst**

ClaimsBridge is an Arnold, Maryland based Software as a Service Healthcare Claims Processing Company. Our Celerity claims adjudication engine is an industry leading system which captures, validates and prices claims for our customers and then routes them to their desired destination. Our solutions empower claims administrators, health networks and employer groups to manage healthcare expenses.

Our go forward direction is to develop new and innovative solutions to maximize savings for our clients. We have experienced extremely high growth in the last 12 months and have very aggressive targets for the coming years.

We are looking for an experienced healthcare claims analyst who is self-motivated to review and price claims, handle assigned client claim inquiries and manage member balance bill and provider appeals in Celerity system.

**Responsibilities**:

- Manage work queues for Medical self-insured claims pricing based on provider contracted rates, Medicare, Medicaid or Usual and Customary based on client plan and network access.
- Adhere to claims processes and procedures as set in company policies.
- Effectively price claims and meet quantity and quality standards. This includes processing all types (Office, Hospital, Surgery Center, etc) of claims while meeting department turnaround time standards.
- Review and resolve assigned client inquiries for claim pricing within expected company policies.
- Monitors the resolution and documentation of client inquiries regarding claim pricing.
- Understand and tracks errors/trends in pricing, overall service results, and recommend actions to improve performance and mitigate risks for company and client.
- Manage assigned Balance Bill and Provider Appeals mailbox, inquiries, and process for response/legal review. Follow company policies and procedures to handle inquiries accurately and timely.
- Assists in answering overflow of outside phone calls, directing the call to the appropriate person or handling the call if that person is not available.
- Customer Service Functions:

- Develop and strengthen relationships with members and clients through phone contact and call resolution.
- Effectively utilize all customer service tools available.
- Review and respond to verbal member and provider disputes.
- Take an active role in Claims and Customer Service Meetings.
- Collaborate with internal colleagues to ensure the highest level of service delivery and to address potential issues.

**Qualifications/Skills**:

- Experience with medical terminology and coding, including CPT, HCPCS, and ICD-10 codes
- Working knowledge of medical contracts, both physician and facility.
- Strong knowledge and experience with various rate structures, such as per diem, Medicare MS-DRG/APC, Percent of Charge, Case Rates, Stop-loss, etc.
- Strong interpersonal organizational and analytical skills and the ability to perform under pressure within rigid time constraints, without the loss of efficiency, quality and professionalism as demonstrated by previous positions held
- Demonstrated ability to analyze situations and data to identify issues, determine points of relevance and proper course of actions
- Superior communication (written and oral), negotiations, teamwork, and organizational skills as demonstrated through previous performance, testing and/or academic background
- Ability to identify, establish and meet goals and objectives

**Required Experience and Essential Job Functions**:

- Bachelor’s degree
- 2+ years of experience in Healthcare Claims Processing
- Performs daily duties and processes claims with mínimal direction and asks questions appropriately.
- High Logic / Math Skills
- Independent problem solving and self-direction are critical.
- Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet.
- Ability to demonstrate a commitment to building new skills and fostering a positive work environment.

ClaimsBridge is a rapidly growing “startup” company. There is a constant stream of exciting and rewarding projects. As with any startup we desire dynamic individuals who are willing to take on a variety of IT tasks. Our high growth potential will create career expansion opportunities, while giving employees direct influence over the company’s success and subsequent rewards.

**Salary**: $65,000.00 - $75,000.00 per year

Pay: $65,000.00 - $75,000.00 per year

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Monday to Friday

Work setting:

- In-person
- Office

**Experience**:

- Microsoft Office: 1 year (preferred)
- Customer service: 1 year (preferred)

Ability to Commute:

- Arnold, MD 21012 (preferred)

Ability to Relocate:

- Arnold, MD 21012: Relocate before starting work (preferred)

Work Location: In person