Claims Analyst I

GI Alliance is seeking a Claims Analyst I.

Duties of this position include, but are not limited to, the following:

Position purpose

The Claims Analyst position ensures that all visits are accounted for with a charge/claim and billed out to insurance or patient appropriately within the timely filing deadlines.

Responsibilities/Duties/Functions/Tasks:

Pre-Charge Posting:

• Work the missing charge reports to ensure all visits are accounted for and linked to a charge.

• Work $0 and unmatched unposted superbills.

• Follow-up with multiple departments as needed and follow proper escalation protocols.

• Support Tier 1 PMD Data Integrity workflows for new acquisitions/integrations and facilitate the transition into our standard workflows.

• Support vendor escalations, exceptions, and general workflows.

Post-Charge Posting:

• Work to resolve claim edits, scrubs, invalids, and rejects in the practice management system and/or clearinghouse to ensure proper claim submission is achieved prior to the timely filing deadline.

• Work closely with leadership and payers to ensure all carriers are set correctly in the systems for electronic and/or payer claim submission.

• Work any Self Pay Discounts or patient plans that need to be reviewed before transferred to patient responsibility.

• Suggest new claim scrubs/edits as needed to continually drive clean claim rates higher.

• Ensure all claim holds are maintained while payers are being contracted and providers loaded until Payer Relations provides clearance for release.

Both:

• Work special projects as assigned.

• Actively participate in root cause analysis and coordinate resolution between appropriate parties, escalating when required.

• Works in coordination with other members of the Central Billing Office as necessary.

• Maintains privacy and confidentiality per policy and HIPAA regulations.

• Performs other related duties as required and assigned.

Qualifications

Qualifications

Education: High school diploma or equivalent.

Experience: 1-3 years of prior physician RCM billing experience is required. Coding or Insurance Follow-up experience preferred.

Performance Requirements:

• Be able to read and understand medical benefits.

• Good communication skills, both written and verbal

• Proficiency in all Microsoft Office applications, particularly MS Word and MS Excel

• Ability to multi-task and prioritize in fast-paced environment.

• Strong attention to detail

• Ability to work efficiently both independently and in a team-oriented environment.

• Ability to perform in a deadline driven environment.

• Self-motivated with initiative

• Strong sense of ethics

Equipment Operated: This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Work Environment: Working remotely.

Physical Requirements: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Position may involve standing, sitting, bending, and reaching. May work at computer monitors for prolonged periods with danger of eye strain and muscle pain. Could cause stress if workload is heavy. May on occasion require light lifting of no greater than 20 pounds and some offsite travel.

GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.

Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.

NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.

No phone calls or agencies, please.

EEO/AA-M/F/disabled/protected veteran