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Job Details

Job Title
: Healthcare Claims Analyst
Required Skills
: AAPC, AHIMA, Billing, claims administration systems, claims auditing, Claims Processing, CPT, Facets, HCPCS, HealthEdge, ICD-10, Trizetto
Location
Duration
: 6 Months contract with possible extension

Job Description

Pay Range: $20 to $30/hr. The pay rate may differ depending on your skills, education, experience, and other qualifications.

Featured Benefits:

  • Medical insurance in compliance with the ACA.
  • 401(k).
  • Sick leave in compliance with applicable state, federal, and local laws.

Job Description:

  • We are seeking a meticulous and experienced Healthcare Claims Analyst to join our team. The ideal candidate will have a strong technical background, experience with automated claims administration systems, and the ability to oversee both medical and prescription claims.

Responsibilities:

  • Analyze and process healthcare claims, including medical and prescription claims, ensuring accuracy and compliance with policies and regulations.
  • Oversee the end-to-end claims process, from submission to resolution, identifying and addressing any discrepancies or issues.
  • Utilize automated claims administration systems to manage and process claims efficiently.
  • Collaborate with healthcare providers, insurers, and other stakeholders to resolve claim disputes and ensure timely payment.
  • Conduct regular audits and reviews of claims to ensure compliance with regulatory requirements and internal policies.
  • Generate and analyze reports on claims activity, identifying trends and areas for improvement.
  • Provide technical support and training to team members on the use of claims administration systems.
  • Stay updated with changes in healthcare regulations and claims processing guidelines.
  • Assist in the development and implementation of policies and procedures to enhance claims processing efficiency and accuracy.

Required Qualifications:

  • Education: Bachelor’s degree in Healthcare Administration, Business Administration, Information Technology, or a related field.
  • Experience: 3+ years of experience in healthcare claims processing, with a focus on both medical and prescription claims.

Technical Skills:

  • Proficient in using automated claims administration systems (e.g., Facets, HealthEdge, Trizetto).
  • Strong understanding of healthcare claims processing, including coding (ICD-10, CPT, HCPCS) and billing procedures.
  • Experience with claims auditing and compliance.
  • Proficient in Microsoft Office Suite (Excel, Word, PowerPoint).
  • Familiarity with database management and reporting tools (e.g., SQL, Tableau).
  • Understanding of healthcare regulations and guidelines (e.g., HIPAA, CMS).

Preferred Qualifications: Additional Skills:

  • Experience with data analysis and reporting.
  • Knowledge of healthcare payer operations and provider networks.
  • Familiarity with electronic data interchange (EDI) processes.
  • Certification in claims processing or healthcare administration (e.g., AAPC, AHIMA).

Soft Skills:

  • Strong analytical and problem-solving skills.
  • Excellent attention to detail and accuracy.
  • Effective communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Strong organizational and time management skills.
  • Ability to manage multiple tasks and prioritize effectively.
  • Continuous learner with a proactive approach to improving processes.

Required Details

Experience
: 5 Years
Travel Required
: No
Clearance Required
: No

Contact Details

Contact person
: Anil Kumar
Phone
: 678-203-2570
Website
: https://suntechnologies.com

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