| Title: Medical Claims Analyst
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| Location: Springfield, MA
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| Job Type: Contract
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| Compensation: $15.00 to $16.00 per Hour
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| Reference Code: 950636-AQG
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Description: Specific functions of the Medical Claims Analyst include:
- Review third party payment for compliance with negotiated contracts
- Determine the correct payments from following contract standards and procedures
- Advise the Billing Department on third party contracts and anticipated payments
- Initiate action to recover any underpayment discrepancies with the appropriate internal or external authority for re-billing or additional payments collection, including resolving operational issues between managed care, Payors, and hospital operational departments
- Utilize stand-alone contract compliance software systems, where applicable, or other methodologies to determine the correct payment
- Document internal system changes necessary to correct any future underpayment discrepancies
- Prepare credentialing packages and provide certifications to health plans and government agencies
- Assist with contract analysis and preparation as well as Payor applications
- Maintain Payor grids
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Requirements: To qualify, you must have the following requirements:
- Bachelor's degree in Business or closely related field (Accounting, Finance, etc.)
- Minimum of two years of previous work related experience in a healthcare setting
- Claims analysis experience
- Contract analysis experience
- Working knowledge of managed care, Medicare, and Medicaid
- In-depth experience in the health field
- Excellent EXCEL Skills are essential!
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