Medical Claims Analyst

Accountemps Sacramento , CA 95815

Posted 2 months ago

Robert Half Healthcare is looking for a Claims Analyst this person will Review, researches, and resolves payment variances to minimize inappropriate payment variances from expected reimbursement, processes payments/refunds/adjustments to comply with regulatory timeframes and in accordance with contracts and policies, and ensures that all potential liabilities are paid in a timely and accurate fashion. Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Sutter Shared Services vision.

Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized. Participates in programs and in using tools in support of building a high performance culture via the standard Sutter Shared Services responsibilities (e.g. performance measurement, people development, customer relationship management, etc.). Top five prinicpal Accoutabilities: Assignment Specific Responsibilities Investigates and addresses over-payments and underpayments with the objective of ensuring appropriate reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner possible Applies knowledge of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible providerinformation and other available data and resources in order to research payment variances, make corrections, and take appropriatecorrective actions to ensure timely claim resolutions Performs refunds, adjustments, write-offs and/or balance reversals in accordance with regulatory timeframes, if charges wereimproperly billed or if payments were incorrect Follows-up on payment variances by contacting patients and 3rd party payers, and supplying additional data, as required Composes adjustment and appeal letters, as needed to resolve underpayments Makes decisions regarding complexity of claim resolution and the appropriateness of transferring account to outsource vendor(s) orother resources for follow-up Documents all actions and encounters in the patient accounting system In initial year, participates in cross-training and job enlargement opportunities for Major job responsibilities.

Works with direct supervisor to identify minor set of responsibilities to develop and perform in support of peaks, valleys and cycles across the Shared Services Organization and individual career growth opportunities. Performs both Major and Minor responsibilities after initial year 60% Continuous Improvement Supports the implementation of programs, policies, initiatives, and tools specific to the Shared Services Organizational process owned by Payer Management across the Shared Services Organization. Participates in all others as appropriate Contributes ideas and actions towards the continuous improvement of Payment Variance related processes within area of influence 10% Performance Management Ensures delivery of business results by meeting or exceeding all individual operating metrics Plans and organizes work so Individual Operating Metrics and Service Level Agreement objectives are realized Recognizes and communicates potential issues to his/her team leader as appropriate 10% If interested please email your resume to

Variance Analysis

Employment Type: Temporary

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Medical Claims Analyst