Claims Resolution Analyst Full Time Remote
Job Id
59877
Job Location
Addison, TX
Employment Type
Full Time-Regular
Industry
Health Care
Concentra
20170926T205024Z
Overview

The Group Health Claims Resolution Specialist works directly with group health payers and Central Billing Offices (CBO) to ensure accurate set-up with our billing systems and payer billing systems, identification and resolution of claim/billing issues.

 

Ensures the delivery of exceptional customer service by putting all customers (internal and external) first and displaying:

  • A healing focus
  • A selfless heart
  • A tireless resolve
Responsibilities

MAJOR DUTIES AND RESPONSIBILITIES:

  • Analyze cumulative claim reports to identify all large volume payment issues  
  • Obtains payer specific billing requirements, claims filing and appeal processes
  • Monitor and report financial impact of newly implemented policies/processes
  • Coordinate and facilitate action plan with payers when problems are identified
  • Works with Central Billing Offices to implement set up of payer specific requirements and processes and correct/resolve billing and claims issues
  • Research and notify involved departments regarding negative financial impacts relating to specific payers
  • Works with group health credentialing department, group health payers, charge entry and Central Billing Offices to ensure proper linkage of providers to facilities and supervising clinicians
  • Analyze payer reports for payment trends to ensure contractual obligations are being met
  • Report, document and maintain claims processing changes to ensure up to date claims filing requirements
Qualifications

EDUCATION/CREDENTIALS:

  • Bachelors degree in a related field required
  • If no degree, 4-6 years additional related/direct experience 

JOB-RELATED EXPERIENCE:

  • 5 – 7 years experience with group health payers regarding claims resolution and set-up requirements 

JOB-RELATED SKILLS/COMPETENCIES:

  • Working knowledge of claims, billing, coding, credentialing and contracting.
  • Working knowledge of computer software applications including word and excel.
  • Working knowledge/use of billing systems.
  • Excellent oral and written communication skills.
  • Excellent relationship building skills, attention to detail, deductive reasoning and decision making skills.
  • Excellent instructional and teaching skills.
  • Ability to manage and monitor multiple tasks and projects. 

WORKING CONDITIONS:

  • Office environment
Benefits
  • 401(k) with Employer Match
  • Medical/Vision/Prescription/Dental Plans
  • Life Insurance/Disability
  • Paid Time Off/Holidays
  • Colleague Referral Bonus Program  

 

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

 

Concentra is an Equal Opportunity Employer, M/F/Disability/Veteran.



We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, sexual orientation, gender identity, disability or medical or veteran status in accordance with federal law. In addition, Concentra Inc. complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it maintains facilities.

Talk to a Recruiter

Tracy Grange
Tracy Grange