EmblemHealth · 1 month ago
Claims Review Analyst
New York, NY
Full-time
Onsite
Entry, Mid Level
$49K/yr - $83K/yr
2+ years expEmblemHealth is a large health system focused on improving health outcomes. The Claims Review Analyst role involves supporting contract performance management, reviewing claims for accuracy, and providing recommendations to minimize errors.
InsuranceNon ProfitWellness
Responsibilities
Support contract performance management of a large health system
Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines
Identify and analyze single issues and trends to determine root causes
Provide recommendations for solutions to minimize errors and delays in systems and/or processes
Monitor system output to ensure proper functioning
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
Required
Bachelor's degree; additional experience/specialized training may be considered in lieu of educational requirements required
2 – 3 years' prior related work experience in professional/facility claims or benefits/billing environment 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
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
Company
EmblemHealth
EmblemHealth is an insurance and wellness company that offers health benefits to consumers, employers, and government purchasers.
1001-5000 employees
H1B Sponsorship
EmblemHealth has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2023 (2)
2021 (2)
2020 (4)
Funding
Current Stage
Late StageLeadership Team
M
Michael Collins
Vice President CRM Applications
Recent News
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