- Execute all Claims Management and Third Party Administrative (TPA) functions for system-wide Domestic and International lines of business
- Accurately audit and analyze medical claims
- Manage timely payer collections and claim adjudication
- Maintain, develop and administer the PNS Contract Management Process
- Back up Team Lead(s) for Para-Claim Parathon solution management
- Analyze claim data to identify anomalies, trends and discrepancies
- Manage the physician claims appeal and reimbursement reconsideration process for all lines of business
- Support Team Lead(s) and leadership in departmental process improvement initiatives
- Support department leaders and Team Lead during payment and reconciliation processes as needed
Requirements
- Associate degree
- 5 years of experience
- Strong background in Medical Insurance Billing and collections, coding, claims regulations, revenue cycle, provider contract management, operational support and registration
- Solid understanding of hospital operations, contractual analysis, FDA health regulations, HIPPA regulations, DRG guidelines
- Exceptional administrative skills
- Thorough understanding of all required fields on a 1500 and/or UB for hospitals, diagnostic facilities and physician practices
- Excellent written and verbal communication skills
- Superb customer service skills
- Ability to work independently, demonstrate a high level of initiative, prioritize deadlines and make decisions
- Results driven, with a desire to work in a fast-paced environment that values collaboration, integrity and customer focus
- Experience preferred with JDA ACO, Web Tool Parathon, EPSi, Soarian Financials, Cerner Power Chart, Business Objectives Enterprise, MS Power BI, Pro Diver or other payer modeling
Core Competencies
Demonstrates expertise in Medical Insurance Billing, Claims Management, and Revenue Cycle processes, with a strong focus on operational support and compliance with health regulations. Proven ability to analyze claim data and manage appeals while supporting departmental initiatives and improving processes.
Highest-signal resume keywords
- Medical Insurance Billing
- Claims Management
- Revenue Cycle
- Contract Management
- HIPAA Regulations
ATS Optimization Keywords
Hard Skills
- Claims Auditing
- Claims Analysis
- Payer Collections
- Coding Regulations
- 1500 and UB Forms Proficiency
Soft Skills
- Exceptional Administrative Skills
- Excellent Communication Skills
- Superb Customer Service Skills
- Independent Decision-Making
- Results Driven
Certifications & Qualifications
- Associate Degree
Industry Keywords
- Claims Regulations
- Operational Support
- Contractual Analysis
- FDA Health Regulations
- DRG Guidelines
Tools & Technologies
- JDA ACO
- Web Tool Parathon
- EPSi
- Soarian Financials
- Cerner Power Chart
- MS Power BI
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Global Claims Management Analyst Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
