Hospital Claims Analyst

Job Type
Full-Time Regular
Somerville MA
Kaitland Manning

Position Summary

Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client.

Duties and Responsibilities

  • Build strong, lasting relationships with clients, payors and BLS personnel
  • Review insurance contracts to gain thorough understanding of payment methodologies
  • Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
  • Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
  • Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and payment posting
  • Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other BLS personnel
  • Support and direct claims to all BLS departments and client onsite analysts
  • Attend client, department and company meetings
  • Comply with federal and state laws, company and department policies and procedures

Skills and Experience

  • Minimum 2 years of experience working in an operational setting, preferably managed care or hospital patient accounts
  • High School diploma or equivalent
  • Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
  • Experience working with ICD-9, CPT-4 and/or HCPCS coding systems
  • Knowledge of insurance submittal procedures and medial forms (including UB04 and CMS1500)
  • Experience performing account resolution with third party payors
  • Accounts receivable collections from payors (no self-pay)
  • Ability to effectively identify and communicate payor trends
  • Organization and documentation skills to ensure timely follow-up and accurate record keeping
  • Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
  • Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
  • Ability to present written routine correspondence (in English)
  • Ability to present ideas on complex, detailed issues with ease
  • Ability to define problems, collect data, establish facts and draw valid conclusions
  • Strong customer service orientation
  • Excellent interpersonal and communication skills
  • Strong team player
  • Commitment to company values
Disclaimer: BLS salaries are intentionally not posted and are based on level of experience. Some sites arbitrarily post salaries but are not an accurate representation.

Candidates must be currently and in the future authorized to work in the United States on a full-time basis. Bottom Line Systems does not sponsor candidates for permanent residency.