Full-time Claims Analyst-Patient Accounting

Job Summary

The Claims Analyst is responsible for tracking, reviewing, and following up on all outstanding patient claims. This includes researching denials and rebilling when appropriate until all payments have been remitted by payors. This role supports the financial integrity of the hospital by identifying discrepancies, preventing fraud, and optimizing claims workflows.

Education & Experience

• High school diploma or general education degree (GED) required.
• Post high school courses in insurance billing, data processing, and medical terminology preferred.
• 1 year of experience in computerized third-party billing of facility and/or professional services required.
• Knowledge of third-party billing requirements required.
• 2 years of previous hospital business office experience preferred.
• 1 year of experience with Meditech and/or SSI preferred.

Essential Functions

• Teams with the leadership to ensure that system deficiencies are eliminated through claim checks, dictionary changes/updates (if applicable), and/or service requests.
• Actively participates in ensuring that processes are effective and efficient and prevents minimizing the likelihood of denials.
• Follows up with third-party payors on unpaid claims until claims are paid or only true self-pay balances remain.
• Researches rejections and denials, rebills corrected claims.
• Forwards claims for additional appeals or reconsiderations to appropriate team members.
• Prepares and submits secondary and tertiary claims to payors for payment either electronically or via paper per the payor’s requirements.
• Maintains confidentiality.
• Supports the hospital and promotes a positive attitude.
• Adheres to dress code, appearance is neat and clean.
• Wears identification while on duty.

License/Certifications

N/A