Insurance Claims Analyst

2 weeks ago


Park Ridge, Illinois, United States Company Set (all job posting) Full time
Job Description

Position Overview

The Insurance Claims Analyst is responsible for optimizing the collection of insurance payments, reducing outstanding balances, and maintaining the integrity of accounts receivable. This role focuses on maximizing reimbursement for services rendered while minimizing the time required to secure payments and sustaining a low Days Sales Outstanding (DSO).

Key Responsibilities

  • Engage directly with payors to resubmit denied or underpaid claims, and audit accounts to ensure accurate processing, payment, and coding.
  • Analyze claim denials to execute necessary appeals for reimbursement.
  • Oversee outstanding accounts receivable for designated payers or divisions.
  • Resolve any outstanding balances efficiently.
  • Conduct follow-ups on accounts receivable aged 31-60 days and 61-90 days, including researching aged account reports and processing problematic Explanation of Benefits (EOBs).
  • Handle special projects related to accounts over 90 days, detailing issues and reporting them to management.
  • Identify and rectify errors, communicating findings to management.
  • Perform random audits to ensure system integrity, payer accuracy, and compliance with contractual reimbursement terms.
  • Complete additional duties as assigned.

Required Skills and Competencies

  • Proficient in Accounts Receivable processes, with the ability to analyze and interpret EOBs and related procedures.
  • Familiarity with organizational policies, including compliance with HIPAA regulations.
  • Knowledge of various insurance operating procedures, including Medicare, Medicaid, HMO/PPO/EPO, Workers' Compensation, and Commercial Insurance.
  • Strong communication skills for effective interaction with insurance payers and colleagues.
  • Detail-oriented with excellent organizational and problem-solving abilities.
  • Able to thrive in a fast-paced work environment.

Qualifications

  • High School Diploma or equivalent.
  • A minimum of 2 years of experience in Healthcare Revenue Cycle Management.
  • Strong analytical and decision-making skills.
  • Familiarity with Federal, State, and third-party payer reimbursement regulations.
  • Certification as a Coder is preferred but not mandatory.


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