Claims Research Analyst

Location: Columbia

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* Verify disbursement requests to ensure the request is valid and appropriately documented. Research rejected, transition, and paid status claims for validity and escalate as appropriate. Use the various systems of the department/company to complete research and gain sufficient knowledge of the claims system and how it relates to other systems.
* May research claims to identify or validate fraud, waste or abuse.
* Monitor inventory reports to ensure claims are resolved accordingly. Provide documentation as requested for audit purposes. May provide written or telephone correspondence to resolve claims issues.
* Research claims as related to billing or crediting groups. Research claims to ensure the proper adjustments are made and groups receive credit or are billed appropriately.
* ** Required

Education:

** High School Diploma or equivalent
* ** Required

Work Experience:

*** 3 years of experience processing claims in a healthcare environment.
* 2 years of experience with claims systems (can be concurrent).
* ** Required

Skills and Abilities:

*** In-depth knowledge of claims payment policies and refund policies.
* Knowledge of related claims software systems.
* Knowledge of medical terminology, CPT IV coding, ICD 9 diagnosis codes, or NCPDP coding as appropriate.
* Good analytical skills and the ability to retrieve and research automated reports.
* Good time management skills and adaptable to change.
* Good communication skills, both written and verbal.
* ** Required Software and Other Tools:
** Standard office equipment.
* *
* Preferred Education:

** Bachelor's degree-in Business, Computer Science, Healthcare Administration, or a related field.
* ** Preferred

Work Experience:

** 4 years-of related experience if lacking degree.
* ** Preferred

Skills and Abilities:

*** Knowledge of processing systems - RMMS, CES, AMMS, ITS, SOND, INFO, third party recovery display, and ALGS.
* Excellent written and verbal communication skills.
* Knowledge of electronic data processing systems and procedures and their integration with the users.
* Ability to run reports using pre-set data retrieval applications, such as DB2 and EZTRIEVE Plus, to obtain information for research and analysis.
* Subsidized health plans, dental and vision coverage
* 401k retirement savings plan with company match
* Life Insurance
* Paid Time Off (PTO)
* On-site cafeterias and fitness centers in major locations
* Education Assistance
* Service Recognition
* National discounts to movies, theaters, zoos, theme parks and more
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