
Claims Analyst
6 days ago
**Job Title:**
As a seasoned healthcare professional, you will be responsible for conducting thorough reviews of medical records and claims to ensure accuracy and compliance with contractual agreements.
Key Responsibilities include:
- Reviewing itemized bills and supporting documentation for completeness and accuracy.
- Verifying that billed services are supported by medical records and documentation.
- Identifying duplicate charges, unbundling, upcoding, non-covered services, or charges inconsistent with guidelines and billing protocol.
- Applying payer rules, federal/state regulations, and internal policies when evaluating charges.
- Comparing charges against contracts, fee schedules, and usual & customary rates.
- Working on appeals related to billing discrepancies.
- Creating detailed documentation related to the above protocol.
**Qualifications:**
- Certification in medical coding or auditing (CPMA preferred).
- 3-4 years of experience in hospital billing, claims auditing, or insurance claims review.
- Knowledge of legal and regulatory aspects of healthcare reimbursement.
- Medical background with MBA/MHA preferred but not required.
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