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Job Title:

Medical Billing Claims Analyst - Eden Prairie, MN

Job Description:

POSITION SUMMARY: The Claims and Operation Analyst is responsible for managing the claim adjudication process for assigned health plans.  The Claims and Operation Analyst is expected to be an expert in Medicare reimbursement rules and procedures as well as ad hoc reimbursement rates for specific plans.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Examine and enter complex claims for appropriateness and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met
  • Ensures timely delivery of claims adjudication and payment to client providers
  • Understands, communicates, and applies Medicare reimbursement rates to related claims.  Researches new reimbursement rates and Medicare fee schedule calculations as needed
  • Analyzes industry billing and claim processing standards to understand workflow needs; communicate industry procedures and recommended actions in an effective manner
  • Approve, pend, or deny payment according to the accepted coverage guidelines
  • Maintaining external and internal customer relations by interacting with staff regarding claims issues. Providing service as the key contact for clients and working as directed with client providers
  • Refers medical claims for further investigation when more information is necessary or when claims are not medically reasonable
  • May assist in training of new groups and new staff as needed; assist the management team in problem resolution, planning and overseeing workflows; testing and preparing documentation and updating current documentation; as well as providing suggestions and recommendations to improve workflows and departmental efficiencies.

 

QUALIFICATIONS:

  • Robust understanding of health care payment cycle; Knowledge and familiarity with health care claim forms and adjudication process
  • Strong Medicare claim billing or adjudication knowledge
  • Ability to speak clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions
  • Ability to perform multiple tasks simultaneously
  • Responds promptly to customer needs; Responds to requests for service and assistance
  • Interprets and presents numerical data effectively
  • Ability to work both independently and with the team
  • Ability to display enthusiasm in working with members and staff to enhance their interest and to support the goals and objectives of the department

 

MINIMUM REQUIREMENTS:

  • Associate’s degree or equivalent relevant prior work experience
  • A minimum of 3 years experience with a health plan, hospital billing, or third party administrator required
  • UB04 and 1500 claim data experience
  • Experience pricing medical claims (facility and physicians)
  • Experience reviewing and interpreting provider contracts and fee schedules

 

 

About Atterro

EQUAL OPPORTUNITY EMPLOYER

Atterro supports affirmative action and equal employment opportunity. Atterro will provide equal employment in employment practices to all associates and applicants for employment. Employment decisions shall be made without regard to any protected characteristic such as, but not limited to, race, color, religion, gender, age, disability, national origin, ancestry, gender identity, sexual orientation, marital status, status in regard to public assistance, disabled veterans, recently separated veterans, Armed Forces service medal veterans and other protected veterans, genetic information and other legally protected classes. Furthermore, Atterro is an E-Verify employer. Information provided on this application will not be used for any discriminatory purposes. Atterro complies with all applicable federal, state and local non-discrimination laws and regulations. Atterro will provide reasonable accommodations in the application or interviewing process. If you need a reasonable accommodation in the application or interviewing process, please contact us.

Click Here for EEO is the Law Federal Guidelines.

Job ID:
338092

Dept ID:
10689

Location:
Eden Prairie, MN
United States of America

Industry:
Legal/Compliance/Finance / Accounting

Job Type:
Temp to Hire Position
Folder Group ID
170

Posted Date:9/5/2018

Domain:atterro

Contact: Danielle.Lambert@hunterhamiltonpr.com

Apply for this Position

Job Title: Medical Billing Claims Analyst

Location: Eden Prairie, MN

Job Type: Temp to Hire Position

Reference ID: 338092

Posted Date: 9/5/2018

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