Analyst, Senior Claims Research

033 Palmetto GBA - Columbia, SC

Full-time

Columbia, SC

About the position

The position involves researching and resolving escalated, complex, and high-profile claims issues within a healthcare environment. The individual will serve as the primary point of contact for various professional and facility providers, ensuring effective communication and resolution of claims payment errors. The role requires efficient and accurate research to meet departmental goals and may involve assisting with provider enrollment, medical reviews, appeals, and financial inquiries.

Responsibilities

• Research and resolve high-profile claims issues.
• Ensure claims processing errors are corrected according to provider reimbursement contracts.
• Serve as the point of contact for various providers to resolve claims payment errors.
• Conduct weekly conference calls with assigned providers to discuss current issues.
• Communicate and educate providers on proper coding, claims filing, pricing concerns, and contract questions.
• Determine if claims payment errors are due to system issues and troubleshoot as necessary.
• Verify disbursement requests for validity and documentation.
• Research rejected, transition, and paid status claims for validity and escalate as appropriate.
• Utilize various departmental systems to complete research and monitor inventory reports for claims resolution.
• Provide documentation for audit purposes and correspond with providers to resolve claims issues.

Requirements

• High School Diploma or equivalent.
• 2 years of combined claims and provider service experience in a healthcare environment.
• 3 years of experience with claims systems.

Nice-to-haves

• Bachelor's degree in Business, Computer Science, Healthcare Administration, or a related field.
• Ability to run reports using pre-set data retrieval applications like DB2 and EZTRIEVE Plus.

Benefits

• Equal Opportunity Employer
• Support for veterans
• Reasonable accommodations for individuals with disabilities