Position Location:

Hospital for Special Care

Scheduled Weekly Hours:

40

Work Shift:

First Shift

Department:

Patient Financial Services

We are dedicated to creating an environment of care and engagement that makes us one of the most desirable places to work, providing exceptional care to each patient each and every day!

***(6150) CLAIMS ANALYST

QUALIFICATIONS

• Associates Degree or equivalent experience.
• Minimum 3 – 5 years experience in Accounts Receivable environment or related accounting area.
• Excellent computer skills utilizing Microsoft Excel, Word and Outlook as well as hospital financial systems.
• Excellent communication and organizational skills as well as ability to utilize Microsoft Outlook daily.
• Strong customer service skills.

JOB SUMMARY
The Claims Analyst analyzes, reviews and resolves daily claim edits requiring intervention. Oversees new edit development. Responsible for management of claim submission software. Monitors daily charge entry, identifies anomalies and resolves concerns timely. Reports inconsistencies and trends to management. Reviews, logs and distributes Allscripts daily reports as assigned. Provides substantial support to patient accounting to ensure the efficient operation of the department.

PHYSICAL DEMANDS

• This position requires walking, standing, sitting, and driving with the ability to lift/carry and push/pull weights of 11-20 pounds occasionally.
• This position also requires the ability to squat, kneel, balance, reach forward and above shoulders, twist, and hear frequently.
• The ability to touch and see is required continuously with gross grasp and fine manipulative maneuvering required continuously.

COGNITIVE DEMANDS

• This position requires excellent computation and problem solving skills, as well as thorough skills in verbal expression/communication and reading/auditory comprehension.

WORK DEMANDS

• This position requires the ability to continuously work independently under a variety of conditions that include moderate noise and frequent interruptions.
• This position requires occasional overtime on an as needed basis.

ESSENTIAL FUNCTIONS

• Analyzes, reviews and resolves all daily claim edits in the organization’s billing systems for both inpatient and outpatient.
• Coordinates with registration, clinical departments, information technology and patient accounting staff to address claim edits and develop new edits.
• Responsible for daily monitoring and review of hospital wide charge entry. Monitors all charge interfaces to ensure daily posting. Ensures that all charges are entered before the month end. Follows up with hospital departments regarding open charge batches.
• Responsible for charge audit posting and follow up. Ensures Patient Account Representatives are aware of changes to accounts.
• Reviews & logs daily Allscripts reports and follows up with appropriate Hospital personnel to ensure reports are reviewed and acted upon if necessary.
• Acts as a resource to all patient accounting staff in regards to the claims processing software. Reports and monitors open issues with the vendor. Keeps current on changes related to software operation and industry changes.
• Reports weekly on Inpatient and Outpatient Pre-Receivable accounts as well as accounts with no charges. Reports monthly on late charges, charges outside service date and other reports as assigned.
• Oversees collection agency placement of accounts. Reviews placement and cancellation reports. Coordinates return of accounts and write off to Bad Debt when appropriate.
• Provides support to ensure the efficient operations of the department as directed by Manager of Patient Accounts and Reimbursement.
• Participates in special projects as requested by and under direction of Manager of Patient Accounts and Reimbursement.

COMPENSATION & BENEFITS
At Hospital for Special Care, we are committed to supporting the health, financial well-being, and professional growth of our team members. The wage range for this position is $21.52 to $32.27. Eligible employees may participate in a comprehensive benefits package that includes employer-subsidized medical and dental, vision insurance; a 403(b) retirement savings plan with an employer match of up to 6%; paid time off; employer-paid life insurance; short-term and long-term disability insurance; a Health Savings Account (HSA) with employer contributions; Flexible Spending Accounts (FSA); an Employee Assistance Program (EAP); tuition reimbursement and professional development opportunities; voluntary benefits, including pet insurance; employee wellness programs with access to our onsite fitness and aquatics center; an employee referral bonus program; and meaningful employee recognition and appreciation initiatives. Eligibility for certain benefits is based on scheduled hours worked.