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Claims Analyst

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 performing follow-up activities to ensure the precision and appropriateness of reimbursements to healthcare providers.

Key Responsibilities:

  • Claims Review & Adjustment: Evaluate, modify, and reprice claims to guarantee accurate reimbursement in accordance with contractual agreements and payer guidelines.
  • Pricing Development: Establish and uphold precise pricing structures to facilitate competitive and profitable billing strategies.
  • Error Resolution: Identify and rectify discrepancies in reconciliation files across multiple platforms and partners.
  • Contract Analysis: Conduct thorough variance analysis to pinpoint overpayments or billing inaccuracies.
  • Data Evaluation: Analyze claims data, produce reports, and assist in trend analysis to ensure the integrity of revenue cycle data.
  • Compliance Monitoring: Remain informed about billing protocols, federal and state regulations, and internal procedures.
  • Confidentiality Maintenance: Uphold strict confidentiality regarding medical records and personal information.

Work Schedule: Flexible hours are available, allowing for any 8-hour shift between Monday and Friday, from 8 am to 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: Skilled in MS Office (Word, Excel, PowerPoint, Outlook) and Windows operating systems.
  • Healthcare Knowledge: Strong grasp of healthcare revenue cycle, claims reimbursement, ICD-10 coding, and CMS guidelines.
  • Analytical Skills: Exceptional problem-solving abilities and meticulous attention to detail.

Additional Skills:

  • Ability to work autonomously and engage in critical thinking.
  • Demonstrated knowledge of billing and coding regulations.
  • Strong analytical capabilities and the ability to deliver results in a dynamic environment.

Why Choose This Opportunity?

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

Are you ready to contribute to the healthcare claims processing field? We look forward to your application.