Our company is growing! We are seeking Claims Analyst Level I with knowledge in the healthcare field.
Research Data Group’s Beacon HCI division is designed to save corporate healthcare payers millions of dollars utilizing a proprietary software tool developed with years of research and knowledge of Federal Billing Guidelines and Regulations in the healthcare industry.
The Level I Claims Analyst is responsible for performing outpatient compliance bill reviews and research as necessary to determine the accuracy of the charges billed by facilities.
This position will consult with the Claims Analyst Level II.
This position will assist with any special projects and/or development of edits.
LOCAL CANDIDATES ONLY.
POSITION IS FULL TIME IN OFFICE
Compliance Review
o Review of UB04 and detailed itemized statements
o Review of automated system analysis
o Perform hospital coding analysis.
e.
g.
Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes.
o Review procedure/facility codes for unbundling, MUE’s, multiple procedures, inpatient codes on outpatient bills, routine services, etc.
o Assist with appeals as needed
o Assist in Internal Code Creation
o Attend required staff training and meetings
o Other special projects as needed
Medical Review and Pricing Analysis
o Review medical record documentation as relates to the UB04 and itemized statement
o Identify compliance and billing errors as well as make appropriate documentation as relates to review performed
o Obtain hospital CMS certification information
KNOWLEDGE, SKILLS & ABILITIES
Two-year experience in Microsoft Office and Excel programs
Proficient data entry skills and accuracy
Ability to follow procedures
Comprehension of hospital coding, billing guidelines and regulations, to include but not limited to, Medicare guidelines, application of Health Insurance Policies, and current industry standards
Exceptional attention to detail
Excellent organizational, analytical, and problem-solving skill
Capable of handling multiple projects in a fast-paced, hyper-growth environment
Strong interpersonal and team-building skills
Experience and Training
1-2 years experience as LPN or RN preferred.
Certified Professional Coder (preferred but not required)
Minimum of three years of nursing experience providing care in an inpatient or outpatient setting is required
One or more years of experience working with healthcare claims that demonstrate expertise in ICD 9/10 Coding, HCPCS/CPT Coding, DRG and medical billing for an Insurance company and/or hospital is required.
One or more years of experience performing medical record reviews is required
Medical Terminology
Problem-solving skills to research and resolve discrepancies, denials, appeals.
(Preferred)
Medicare Appeals processing background.
(Preferred)
RAC Audit experience (Preferred)
Knowledge of Medical fraud/abuse healthcare laws (Preferred
Rev cycle management (Preferred)
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