Claims Analyst

Summary:
The Claims Analyst reports to the Manager of Claims Administration Follow-up. Under general direction and within established Lifespan policies and procedures performs all duties necessary to ensure all projects ad-hoc reports and Governmental reporting requirements are processed accurately and within mandated time frames to ensure a positive reimbursement impact. Takes appropriate steps to review identify and reduce issues resulting from project research related to Accounts Receivable follow-up activities for Lifespan Corporate Services and its affiliates.

 

Responsibilities:
Assists the Supervisors Manager and Claim Director in compiling any necessary statistics needed for follow-up activities.



Creates generates and distributes Month end aging reports and summaries.



Ensures timely and accurate processing of adjustments and denials from payers. Initiates action to resolve accounts. Meets with payers Denials Management Staff and PFS staff as necessary to resolve disputes related to accounts receivable.



Processes all necessary online adjustments or changes as needed such as adding/deleting insurance information insurance priority changes balance transfers demographic changes contractual allowances any other routine patient accounting adjustment not requiring supervisor approval.



Continually evaluates work flow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients.



Ensures accuracy efficiency and integrity of all information systems pertaining to all payer including maintaining the Follow Up data base.



Researches payer issues resulting in payment delays denials underpayments and processing deficiencies and recommends changes as appropriate.



Responds to requests from various hospital personnel related to Medicare or Medicaid regulations as it applies to hospital and professional billing and reimbursement providing supporting resource information.



Ensures Medicare and Medicaid 838 and 3 day overlap reports are accurately completed as required by federal regulation to ensure no interruption to Medicare and Medicaid monies paid to each affiliate.



Reviews recommendations of CED requests from Claims Administration Follow-Up Representatives to ensure all steps have been taken to ensure accuracy and may refer back to staff or forward on to supervisor.



Ensures all shared interdepartmental accounts receivable related files are completed accurately and referred to the appropriate department to ensure timely claims processing.



Creates generates and maintains ad hoc reports as requested by the Senior Claims Analyst to assist in the daily operation of the department.



Coordinates all assigned activities between Lifespan and its Contracted Billing Agency for Out of State Medicaid billing and accounts receivable.



Participates in staff meetings councils quality improvement teams and other such meetings and committees as required.



Develops and maintains working relationship with Lifespan affiliate departments as needed to ensure fully data exchange.



Responsible for completing spreadsheets needed to respond to internal and external audits.



Maintains up to date knowledge of changes in regulations that impact claims processing



Performs other duties as necessary.

 

Other information:
BASIC KNOWLEDGE:



Associate�s degree in accounting business office practices computer science or other related area or equivalent experience.



EXPERIENCE:



Three year�s experience in patient accounting. Experience should demonstrate thorough knowledge of claims administration in similarly complex healthcare organization. Must be familiar with ICD-9/10 CPT-4 coding UB04 and HCFA 1500 claims administration. Ability to perform financial analysis. Comprehensive knowledge of patient accounting activities in an automated networked multiple hospital environment. Detailed knowledge of regulatory requirements

 

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: Corporate Headquarters USA:RI:Providence

 

Work Type: Full Time

 

Shift: 1

 

Union: Non-Union


Work Schedule M-F 8 AM -4:30 PM