Claims Analyst

Hospital for Special Care•New Britain, CT

1d•$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 development of new edits, manages claim submission software, and monitors daily charge entry to identify anomalies and resolve concerns in a timely manner. The analyst reports inconsistencies and trends to management, reviews, logs, and distributes daily Allscripts reports, 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 departments, and vendors to resolve claim and charge issues. It monitors charge interfaces and posting, follows up on open charge batches, supports charge audits, and oversees collection agency account placements, returns, cancellations, and write-offs when appropriate. The analyst also keeps current with software and industry changes, prepares scheduled reports, and participates in special projects as directed.

Requirements

Associate degree or equivalent experience.
Minimum 3–5 years of experience in an Accounts Receivable environment or related accounting area.
Excellent computer skills, including 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.
Thorough verbal expression and communication skills, and reading and auditory comprehension skills.
Ability to work independently under a variety of conditions, including moderate noise and frequent interruptions.
Ability to walk, stand, sit, and drive; occasionally lift, carry, push, or pull 11–20 pounds; frequently squat, kneel, balance, reach forward and above the shoulders, twist, and hear; and continuously touch, see, and perform gross grasp and fine manipulative movements.
Ability to work occasional overtime as needed.

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 and month-end charge entry.
Follow up with hospital departments regarding open charge batches and handle charge audit posting and follow-up.
Ensure Patient Account Representatives are informed of account changes.
Review and log daily Allscripts reports and follow up with appropriate hospital personnel to ensure reports are reviewed and acted upon as necessary.
Act as a resource to patient accounting staff regarding claims processing software.
Report and monitor open issues with the software vendor and stay current on software operation and industry changes.
Prepare weekly reports on inpatient and outpatient pre-receivable accounts and accounts with no charges.
Prepare monthly reports on late charges, charges outside the service date, and other assigned topics.
Oversee collection agency placement of accounts and review placement and cancellation reports.
Coordinate return of accounts and write-off to Bad Debt when appropriate.
Support efficient department operations as directed by the Manager of Patient Accounts and Reimbursement.
Participate in special projects as requested and directed by the Manager of Patient Accounts and Reimbursement.