Assistant Claims Analyst

Job Description

Coordinates with stakeholders to ensure effective communication and collaboration, performs claims analysis before submission to insurance companies, and verifies Inpatient (IP) and daycare bills as well as high-value Outpatient (OP) bills for accuracy. Collaborates with the insurance coordinator to address approval-related issues and with the back-end billing team for edits or changes.

Responsibilities

• Coordinates with stakeholders to ensure effective communication and collaboration.
• Performs claims analysis before submitting them to insurance companies.
• Verifies each Inpatient (IP) and daycare bill, checking approval code, approval validity, approved amount, and billed amount.
• Verifies high-value Outpatient (OP) bills, including network, approval code, approval validity, approved amount, and billed amount.
• Coordinates with the Insurance coordinator to address missing or expired approvals, or bills without proper approval codes.
• Coordinates with the back-end billing team for bill edits or encounter changes.
• Coordinates with the back-end billing team regarding changes in approved and billed Diagnosis Related Group (DRG) amount, DRG code, and outlier amount.
• Prioritizes accurate, thorough, and appropriate work.
• Anticipates and prioritizes tasks to support department needs, adhering to policies and procedures.
• Identifies and analyzes problems, takes action to resolve them, applies sound judgment, and takes responsibility for their resolution.
• Supports hospital and department policies and procedures.

Qualifications

• Bachelor’s Degree in any field, Medical preferred

PROFESSIONAL EXPERIENCE:

• Minimum of zero (0) to two (2) years of experience within the Claims Division.
• Knowledge of Insurance Companies’ requirements in a Hospital.
• Knowledge of Hospital Operations.
• Skills in Microsoft Office (e.g. Excel, Word, PowerPoint, Outlook, etc.).
• Skills in leadership and relationship management.
• Ability to speak and write in English fluently.