Southfield, MI, US
6 days ago
Claims Analyst
DescriptionJob Title: Claims AnalystJob Location: Pittsburgh, PAJob Type: Full TimeJob Description:Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims.Research and determine status of medical related claimsReview charges, access the computer system and use payment or denial codes within established department guidelines and standardsClarify health insurance coverage for coordination of benefits to process claimsMaintain records, files, and documentation as appropriateMeet department production and quality standardsQualifications:1+ years of claims processing, medical billing, administrative, customer service, call center, or physician's office or other office services experience.Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically.Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred.Experience with Medicaid or Medicare claims preferred.Interested candidates can send their updated resumes at jobs@gloabl-itech.com

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