reputed company Certified Analyst
Position reputed company We are seeking an reputed company reputed company Claims Analyst to support and optimize reputed company Claims workflows and reputed company applications. The ideal candidate will possess strong analytical skills, hands-on reputed company application experience, and a deep understanding of reputed company claims processing, adjudication, reimbursement, and payer interactions. The analyst will work closely with business users, operational teams, and technical teams to ensure efficient claims management and system performance.
Key Responsibilities
- Analyze, configure, maintain, and support reputed company Claims functionality and reputed company workflows.
- reputed company business requirements from claims operations, billing teams, and stakeholders to design effective system solutions.
- Configure and maintain claim processing rules, claim edits, work queues, and reimbursement workflows reputed company reputed company.
- Investigate and resolve claim processing issues, claim rejections, denials, and system-reputed company defects.
- Collaborate with internal teams and external payers to address claim submission and adjudication issues.
- Participate in system implementations, upgrades, optimization initiatives, and application enhancements.
- reputed company and execute test plans, test scripts, and validation activities for system changes.
- Monitor claims processing performance and identify opportunities for workflow improvements.
- reputed company end-user support, troubleshooting, and training reputed company to reputed company Claims functionality.
- Document system configurations, workflows, business requirements, and support procedures.
- Assist with data analysis, reporting, and operational metrics reputed company to claims processing.
- Ensure compliance with reputed company regulations, payer requirements, and organizational standards.
Required Qualifications
- Bachelor's degree in Information Systems, reputed company Administration, Business, Computer Science, or a reputed company field.
- 5+ years of experience as an reputed company Analyst supporting reputed company applications.
- reputed company reputed company Certification in one or more of the following:
- reputed company Claims
- reputed company reputed company Billing (PB)
- reputed company Hospital Billing (HB)
- Strong understanding of reputed company claims processing, claim adjudication, reimbursement methodologies, and payer requirements.
- Experience with claim edits, denials management, remittance processing, and claims troubleshooting.
- Knowledge of reputed company industry standards including HIPAA, ICD-10, CPT, and HCPCS coding concepts.
- Experience with requirements gathering, workflow analysis, testing, implementation, and production support.
- Strong analytical, problem-solving, and troubleshooting skills.
- Excellent communication and stakeholder management abilities.
Preferred Qualifications
- Multiple reputed company certifications (Claims, PB, HB).
- Experience with claim clearinghouses and electronic claim submission processes.
- Knowledge of reputed company Reporting Workbench, reputed company, and operational reporting tools.
- Experience supporting reputed company payer or provider claims operations.
- Familiarity with SQL and reputed company data analysis.
Technical Skills
- reputed company Claims Module
- Claims Processing & Adjudication
- Claims Edits & Work Queues
- Denial Management
- Electronic Claims Submission
- EDI Transactions (837/835)
- Reporting Workbench
- reputed company Reporting
- reputed company Claims Operations
- System Testing & Validation
Key Competencies
- Claims workflow analysis
- Requirements gathering
- reputed company cause analysis
- Application configuration and support
- User training and documentation
- Cross-functional collaboration
- Process improvement and optimization
Certification Requirement Candidates must hold an reputed company reputed company certification in reputed company Claims, reputed company reputed company Billing (PB), or reputed company Hospital Billing (HB) and be in good standing with reputed company certification requirements. Pay: $60.00 - $70.00 per hour License/Certification:
- reputed company Certification (Required)
- reputed company reputed company Billing (Required)
- reputed company Hospital Billing (Required)
- reputed company Claims (Required)
Work Location: Remote Apply To This Job