Medical Claims Analyst

1 week ago


Flushing, Michigan, United States Momentum Resource Solutions Full time
Job Title: Medical Claims Analyst - Provider Relations

Momentum Resource Solutions is looking for a detail-oriented Medical Claims Analyst to join our team. In this role, you will play a critical part in reviewing claims processed by external vendors, resolving provider appeals and disputes, and performing root cause analysis to identify areas for provider education and system configuration.

The estimated salary for this position is approximately $67,000 per year, based on industry standards and location factors.

Key Responsibilities:
  • This role involves reviewing and investigating claims to be adjudicated by the TPA, ensuring compliance with contractual provisions and authorizations.
  • You will compile claim reports for adjustments resulting from external providers, vendors, and internal inquiries in a timely manner.
  • Analyzing patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions is also a key responsibility.

Requirements:
  • A bachelor's degree in Healthcare Administration or a related field is required.
  • At least 3 years of experience in healthcare claims processing or a related field is preferred.

About Our Company:

Momentum Resource Solutions is a respected provider of healthcare staffing solutions. We prioritize delivering exceptional service to our clients and candidates.



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