Insurance Analyst

• Process, review and submit insurance claims to third-party payers (Medicare, Medicaid, private insurers) based on medical coding, billing data, and patient insurance information.

• Ensure that claims are complete, accurate, and compliant with payer-specific rules and guidelines.

• Investigate and analyze denied claims, identifying the cause of denials (e.g., coding errors, missing documentation, eligibility issues).

• Work with coding and clinical teams to resolve issues and resubmit claims for payment.

• Appeal denied claims and work to ensure that payments are received promptly.

• Review insurance company remittance advice (EOBs) to confirm payments are consistent with the terms of the payer contract.

• Resolve discrepancies between billed amounts and paid amounts, ensuring accurate adjustments and patient responsibility.

• Communicate with payers to resolve any outstanding payment issues.

• Ensure proper verification of patient insurance eligibility and benefits prior to service delivery.

• Confirm that required pre-authorizations or referrals are obtained for specific procedures, treatments, or hospital admissions.

• Track and report on key performance indicators (KPIs) related to claims processing, such as claim approval rates, denials, and aged accounts.

• Generate reports to identify trends in claims issues, payer performance, and payment delays.
• Post insurance and patient payments accurately into billing systems and reconcile transactions to ensure proper allocation.

• Stay up-to-date with changes in healthcare regulations, payer policies, and billing codes (ICD-10, CPT, HCPCS).

• Ensure that the department remains compliant with federal, state, and payer-specific billing requirements, including HIPAA.

• Assist patients and other stakeholders with insurance-related inquiries, helping to explain coverage issues, billing questions, or denials.

• Other duties as assigned

• Experience in healthcare billing or revenue cycle management, with a solid understanding of insurance processes and claim handling.

• Strong analytical and problem-solving abilities.

• Knowledge of insurance terminology, healthcare regulations, and payer-specific guidelines.

• Familiarity with billing software and electronic health record (EHR) systems.

• Excellent communication skills, both written and verbal.

• Attention to detail and ability to prioritize tasks in a fast-paced environment.

• Proficiency with Microsoft Office suite

• Implement and act in accordance with the organization's information security policies;
• Protect assets from unauthorized access, disclosure, modification, destruction or interference;
• Execute particular security processes or activities;
• Ensure responsibility is assigned to the individual for actions taken; and
• Report security events or potential events or other security risks to the InfoSec department.

Min/Preferred

Education Level

Description

Minimum

High School or GED

High school diploma or equivalent required.

Preferred

2 Year / Associate Degree

Associate's degree in Healthcare Administration, Business, or a related field preferred.

Minimum Years of Experience

Comments

2

2 years of experience with medical billing required.

Min/Preferred

Certification

Description

A combination of experience and advanced education may be substituted. Background checks and drug test required.