200+ applicants

Company

Original Job Post

EmblemHealth · 4 days ago

Healthcare Claims Review Analyst

New York, NY

Full-time

Remote

Entry, Mid Level

$45K/yr - $77K/yr

2+ years exp

Wonder how qualified you are to the job?

Maximize your interview chances

InsuranceNon Profit

Insider Connection @EmblemHealth

Discover valuable connections within the company who might provide insights and potential referrals, giving your job application an inside edge.

Responsibilities

Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review.

Maintain and organize detailed information on claims dispute files to ensure appropriate and comprehensive data is returned to the provider timely.

Track issues and monitor trends to support their resolution.

Identify potential/actual claims problems (single or recurring/trending) and document root cause analysis; present findings to management.

Improve quality, enhance workflow, and provide efficiencies within departments, identify opportunities for improvements; develop and present recommendations for changes.

Conduct regular meetings with the assigned provider groups for status of AR files and recycles.

Support departmental goals for cycle time by organizing and tracking claims for review.

Monitor and provide timely responses for the designated provider group emails and AR files.

Perform other related tasks as directed or required.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claim processingMedical terminologyICD/CPT codingDRG reimbursementEDP testing proceduresMS OfficeFacetsContractual interpretationOperational improvementProject managementInformation communicationProblem-solvingAnalyticalInterpersonalTeamwork

Required

Bachelor’s Degree

2 – 3 years’ prior related work experience in professional/facility claims or benefits/billing environment (Required)

Additional experience/specialized training may be considered in lieu of educational requirements (Required)

Strong knowledge of claim processing policies and procedures (Required)

Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures (Required)

Proficiency with MS Office applications (word processing, database/spreadsheet, presentation) (Required)

Facets Experience (Required)

Ability to accurately interpret information from contractual and technical perspectives (Required)

Must be conscientious and detail oriented; ability to recognize unusual patterns and troubleshoot for operational improvement and efficiencies (Required)

Strong analytical and problem-solving skills (Required)

Ability to effectively work on multiple projects/tasks with competing priority levels and deadlines (Required)

Ability to effectively absorb and communicate information (Required)

Strong Interpersonal and teamwork skills (Required)