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Claims Management Specialist

2 months ago

Fort Worth, Texas, United States CornerStone Staffing Full time

Company Overview: CornerStone Staffing is collaborating with a prominent healthcare organization to identify a skilled Claims Processor/Revenue Cycle Analyst.

Position Summary: The Claims Processor is tasked with the analysis and oversight of claims audit data across various systems. This role involves executing follow-up activities to guarantee the accuracy and appropriateness of reimbursements made to healthcare providers.

Key Responsibilities:

  • Claims Analysis & Adjustment: Evaluate, modify, and reprice claims to ensure correct reimbursement in accordance with contractual agreements and payer guidelines.
  • Pricing Structures: Establish and uphold accurate pricing frameworks to facilitate competitive and profitable billing strategies.
  • Error Identification: Identify and rectify discrepancies in reconciliation files across multiple platforms and partners.
  • Contract & Reimbursement Analysis: Conduct thorough variance analysis to detect overpayments or billing inaccuracies.
  • Data Analysis: Examine claims data, produce reports, and assist in trend analysis to maintain precise revenue cycle information.
  • Regulatory Compliance: Remain informed about billing protocols, federal and state regulations, and internal procedures.
  • Confidentiality: Uphold strict confidentiality regarding medical records and personal information.

Work Schedule: Flexible hours are available, allowing you to select any 8-hour shift from Monday to Friday, between 8 am and 5 pm.

Essential Skills & Qualifications:

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

Additional Requirements:

  • Ability to work independently and engage in critical thinking.
  • Demonstrated knowledge of billing and coding regulations.
  • Strong analytical skills with the capacity to deliver results in a dynamic environment.

Why Consider This Opportunity?

  • Career Advancement: Direct hire opportunity with a respected healthcare organization.
  • Flexibility: Benefit from remote work options following initial training.

Ready to make a significant contribution in the realm of healthcare claims processing?