Medical Claim Analyst

Overview

The Medical Claim Analyst is responsible for examining provider coding and reimbursement denial disputes as part of the Provider Coding and Reimbursement team. This role involves assessing claim re-submissions, resolving or preparing claims for clinician examination, conducting research using multiple claims systems, and maintaining detailed claim records.

Key Responsibilities

• Evaluate submitted claims and manage re-submissions for accuracy.
• Resolve claim issues or prepare claims for further clinical review.
• Investigate claims utilizing systems such as ASD, ACAS/EWM, and document their histories thoroughly.

Required Skills and Qualifications

• Strong familiarity with the ACAS claims platform, including claim rework and related system functions like EWM, ASD, and ECHS.
• Minimum of a high school diploma.
• At least one year experience processing claims using the ACAS system.
• Proficient with Microsoft Excel for claims data management and analysis.
• Strong analytical aptitude, effective communication capabilities, and the ability to multitask efficiently.

Preferred Qualifications

• Prior experience with ACAS/EWM systems.
• Background in claims processing or similar operational functions.
• High attention to detail and understanding of benefits policies.

Work Environment & Compensation

This is a full-time, on-site position offering competitive salary and a robust benefits package dedicated to supporting employee wellness and success.