Claims Analyst

Hospital for Special Care•New Britain, CT

18h•$22 - $32

About The Position

The Claims Analyst analyzes, reviews, and resolves daily claim edits requiring intervention for inpatient and outpatient claims. The role oversees new edit development and manages claim submission software. It monitors daily charge entry and charge interfaces, identifies anomalies, resolves concerns, and ensures charges are posted and entered before month-end. The Claims Analyst reviews and distributes daily Allscripts reports, reports inconsistencies and trends to management, and provides substantial support to patient accounting to help ensure efficient department operations. The position coordinates with registration, clinical departments, information technology, patient accounting staff, hospital personnel, and software vendors. It supports charge audits, claim processing, reporting, and collection agency account placements, and participates in special projects as directed by the Manager of Patient Accounts and Reimbursement. This is a 40-hour-per-week, first-shift position. Work may involve moderate noise and frequent interruptions, and occasional overtime as needed. The role requires walking, standing, sitting, driving, lifting/carrying and pushing/pulling 11–20 pounds occasionally, and various other physical activities. The wage range is $21.52 to $32.27. Eligible employees may participate in a comprehensive benefits package, with eligibility for certain benefits based on scheduled hours worked.

Requirements

Associate degree or equivalent experience.
A minimum of 3–5 years of experience in an Accounts Receivable environment or related accounting area.
Excellent computer skills using Microsoft Excel, Word, and Outlook, as well as hospital financial systems.
Excellent communication and organizational skills, including the ability to use Microsoft Outlook daily.
Strong customer service skills.
Excellent computation and problem-solving skills, verbal expression and communication skills, and reading and auditory comprehension.
Ability to work independently under a variety of conditions, including moderate noise and frequent interruptions.

Responsibilities

Analyze, review, and resolve daily inpatient and outpatient claim edits in the organization’s billing systems.
Coordinate with registration, clinical departments, information technology, and patient accounting staff to address claim edits and develop new edits.
Monitor and review hospital-wide charge entry and charge interfaces to ensure daily posting, ensure charges are entered before month-end, and follow up with hospital departments about open charge batches.
Manage charge audit posting and follow up, and ensure Patient Account Representatives are aware of account changes.
Review and log daily Allscripts reports and follow up with appropriate hospital personnel to ensure reports are reviewed and acted upon when necessary.
Serve as a resource to patient accounting staff regarding claims processing software; report and monitor open vendor issues; and keep current on software operation and industry changes.
Prepare weekly reports on inpatient and outpatient pre-receivable accounts and accounts with no charges, and monthly reports on late charges, charges outside service dates, and other assigned topics.
Oversee collection agency placement of accounts, review placement and cancellation reports, and coordinate account returns and write-offs to Bad Debt when appropriate.
Provide support for efficient department operations as directed by the Manager of Patient Accounts and Reimbursement.
Participate in special projects as requested by and under the direction of the Manager of Patient Accounts and Reimbursement.