Claims Management Specialist
2 weeks ago
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 executing follow-up tasks to guarantee the accuracy and appropriateness of reimbursements made to healthcare providers.
Key Responsibilities:
- Claims Review & Adjustment: Evaluate, modify, and reprice claims to ensure precise reimbursement in accordance with contractual agreements and payer guidelines.
- Pricing Strategy Development: Establish and uphold accurate pricing frameworks to facilitate competitive and profitable billing practices.
- Error Detection: Identify and rectify discrepancies in reconciliation files across multiple platforms and partners.
- Contractual & Reimbursement Evaluation: Conduct thorough variance assessments and pinpoint overpayments or billing inaccuracies.
- Data Examination: Analyze claims data, produce reports, and assist in trend analysis to ensure the integrity of revenue cycle information.
- Compliance Adherence: Remain informed on billing protocols, federal and state regulations, and internal policies.
- Confidentiality Maintenance: Uphold strict confidentiality regarding medical records and personal data.
Work Schedule: Flexible hours are available; 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: Skilled in MS Office (Word, Excel, PowerPoint, Outlook) and Windows operating systems.
- Industry Knowledge: Strong grasp of healthcare revenue cycle, claims reimbursement, ICD-10 coding, and CMS guidelines.
- Analytical Competence: Exceptional problem-solving skills and meticulous attention to detail.
Additional Competencies:
- Ability to work autonomously and engage in critical thinking.
- Demonstrated understanding of billing and coding regulations.
- Strong analytical capabilities and 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 to healthcare claims processing?
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