Complex Clinical Claims Analyst
M
MachinifyHealthcare Intelligence
Remote - USFull-TimeMiddle
Salary100,000 - 110,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 2+ years in complex claims/itemized bill review; 3+ years in healthcare billing and coding
- Required Skills
- Data AnalysisMicrosoft ExcelPowerPoint
Requirements
- Bachelor of Science in Nursing, RN, LPN or LVN.
- 2+ years of experience in complex claims/itemized bill review.
- 3+ years of experience in healthcare billing and coding.
- Background in healthcare payment integrity industry.
- Exceptional research and data analysis skills.
- Strong analytical, organizational, and problem-solving skills.
- Advanced skills in Microsoft Office (Excel, PowerPoint, Word).
- Experience working with multiple monitors.
- Proven success in a remote working environment.
- Ability to work independently and communicate change across the business.
Responsibilities
- Perform detailed clinical and coding review of facility claims, including review of the detailed itemized statement, the UB-04, and all medical records.
- Assess all clinical aspects of the claim, including the appropriateness of the level of care billed throughout the claim.
- Research client specific medical policies, manufacturer information, and clinical/coding guidelines to identify experimental and investigation charges.
- Provide evidence and references to internal and external partners supporting industry standards, auditing guidelines, and review stances.
- Analyze medication charges to determine correct pharmacy utilization and potential off-label use.
- Assess the claim for charges related to Do Not Bill Events or Hospital Acquired Conditions.
- Review, expand, and cultivate resources to build up complex claims review content.
- Act as a subject matter expert for the overall product, including participating in sales calls and coordinating test claims.
- Manage the appeal language for client requested response letters and assist in staff training processes.
View Full Description & ApplyYou'll be redirected to the employer's site
