Claims Processor

3 weeks ago

Fort Worth, Texas, United States CornerStone Staffing Full time

CornerStone Staffing is partnering with a leading healthcare company to find a talented Claims Processor/Revenue Cycle Analyst.

This role involves analysis and monitoring of claims audit data across multiple platforms, ensuring accurate reimbursement to healthcare providers.

Key responsibilities include:

  • Claims Analysis & Adjustment: Review, adjust, and reprice claims to ensure accurate reimbursement per contractual agreements and payer guidelines.
  • Pricing Structures: Develop and maintain precise pricing structures to support competitive and profitable billing strategies.
  • Error Identification: Detect and resolve errors in reconciliation files across various platforms and partners.
  • Contract & Reimbursement Analysis: Perform detailed variance analysis and identify overpayments or billing errors.
  • Data Analysis: Analyze claims data, generate reports, and support trend analysis to ensure accurate revenue cycle data.
  • Regulatory Compliance: Stay current on billing protocols, federal and state regulations, and internal procedures.
  • Confidentiality: Maintain strict confidentiality of medical records and personal information.

Essential skills and qualifications include:

  • Experience: Minimum of 3 years in claims processing, repricing, pricing configuration, or provider maintenance.
  • Education: High School Diploma or equivalent (verification required).
  • Technical Skills: Proficiency in MS Office (Word, Excel, PowerPoint, Outlook) and Windows operating systems.
  • Knowledge: Strong understanding of healthcare revenue cycle, claims reimbursement, ICD-10 coding, and CMS guidelines.
  • Analytical Skills: Excellent problem-solving abilities and attention to detail.

To be successful in this role, you should be able to work independently and think critically, with a strong analytical mind and ability to deliver results in a fast-paced environment.

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