Healthcare Claims Analyst

At Accessia Health, our commitment to Compassion, Accountability, Person-Centered Care, and Service isn't just a set of words; it's the foundation of who we are. These values drive us to build strong relationships, foster innovation, and achieve excellence in everything we do.

Summary:

Healthcare Claims Analyst reports directly to the Director of Compliance and supports the organization's healthcare claims processing. This role involves meticulous review and verification of patient assistance claims to ascertain their accuracy and compliance with policies. The Healthcare Claims Analyst will ensure timely reimbursement to patients and healthcare providers for services rendered, while also complying with applicable rules and regulations.

Salary: This role has a target salary of $45,000 to $60,000 annually, based upon various factors including location, experience, and education.

Core Job Responsibilities:

Payment Validation

• Examine patient assistance invoices, including explanation of benefits and health care claim forms, for accuracy and completeness according to organizational guidelines and relevant laws and regulations.


• Verify patient account information against program specifications.


• Analyze procedures and diagnoses using CPT and ICD codes.


• Support the Patient Services department by responding timely to questions and payment inquiries.


• Compare and analyze assistance payment requests, partnering with the clinical personnel to understand program guidelines.


• Contact providers, patients, and other payees as needed to validate documentation.


• Calculate payments such as claims/invoices and reimbursement claiming, according to established policies and procedures, approving or rejecting claims based on such.


• Perform quantitative and qualitative analysis of assistance data.


• Identify and address any errors or discrepancies.

Process Improvement

• Provide feedback on staff adherence to program guidelines.


• Collaborate with management to identify and implement the best practices and improvements for patient assistance payment processes and systems.


• Maintain a thorough understanding of all programs and their requirements.


• Handle data with confidentiality and adhere to HIPAA regulations.

Desired Education and Experience:

• Minimum of 5 years of working experience in medical claims processing, analyzing and calculating data


• Proficiency in medical terminology, CPT and ICD-10 coding and insurance billing procedures


• Possession of relevant certification in medical coding, such as Certified Medical Coder (CMC) or successful completion of a graduate certification program in healthcare preferred.


• Familiarity with regulatory requirements for medical billing and coding

Essential Traits:

• Thorough/Detailed-Oriented Work Method: This trait involves a meticulous approach to tasks, focusing on accuracy and completeness to ensure high-quality outcomes.


• Fiscally Responsible Mindset: Individuals with this trait conscientiously manage budgets and resources, aiming to maximize value and prevent waste.


• Analytical Skills and Objective Judgment: This refers to the ability to assess situations, data, and information critically and impartially to make well-informed decisions.


• Problem Solving/Analysis: Characterized by the ability to identify issues, analyze problems, and devise efficient solutions through logical reasoning.


• Effective Communicator: This trait denotes the capability to convey information clearly and persuasively, ensuring understanding and engagement among diverse audiences.


• Collaboration/Interpersonal Skills: Involves working well with others, building positive relationships, and contributing to a team-oriented environment through empathy and interpersonal understanding.


• Ability to be Flexible Including Adjusting to Changing Priorities and Circumstances: Represents the capacity to adapt to new challenges, shifting deadlines, and evolving goals with resilience and a positive attitude.