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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 will play a crucial role in the analysis and oversight of claims audit data across various systems. This position involves performing follow-up activities to guarantee the precision and appropriateness of reimbursements to healthcare providers.

Key Responsibilities:

  • Claims Review & Adjustment: Evaluate, modify, and reprice claims to ensure correct reimbursement in accordance with contractual agreements and payer guidelines.
  • Pricing Strategies: Establish and maintain accurate pricing structures to facilitate competitive and profitable billing practices.
  • Error Detection: Identify and rectify discrepancies in reconciliation files across multiple platforms and partners.
  • Contract & Reimbursement Evaluation: Conduct thorough variance analysis to uncover overpayments or billing inaccuracies.
  • Data Analysis: Examine claims data, produce reports, and assist in trend analysis to ensure precise revenue cycle information.
  • Regulatory Adherence: Remain informed about billing protocols, federal and state regulations, and internal policies.
  • Confidentiality Maintenance: 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 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 Proficiency: Competence in MS Office (Word, Excel, PowerPoint, Outlook) and Windows operating systems.
  • Industry Knowledge: Comprehensive understanding of healthcare revenue cycle, claims reimbursement, ICD-10 coding, and CMS guidelines.
  • Analytical Skills: Strong problem-solving capabilities and meticulous attention to detail.

Additional Requirements:

  • Ability to work autonomously and think critically.
  • Demonstrated knowledge of billing and coding regulations.
  • Strong analytical skills with the ability to deliver results in a dynamic environment.

Why Consider This Opportunity?

  • Career Advancement: Direct hire opportunity with a respected healthcare organization.
  • Work Flexibility: Enjoy the advantages of remote work following initial training.

Are you ready to make a significant contribution in the field of healthcare claims processing? We look forward to your application.