Transplant Claims Analyst - 2384

  • Free
  • Published date: October 1, 2015 06:35
    • Cincinnati, Ohio, United States

Company Name:
Absolute Opportunities Test

Transplant Claims Analyst - 2384

Role: Nursing or Physician and other healthcare related opportunities
Relocation Available: Yes
Location: Ohio
Town / City: Cincinnati
Job Type: Permanent full-time
Job description:
The Claims Analyst is primarily responsible for the thorough review of transplant and other managed care contracts, and comparison of such contracts against transplant claims and cases, in order to identify underpayments for the assigned client.

Essential Duties and Responsibilities:
Build strong, lasting relationships with clients, payors and company personnel
Review transplant and other insurance contracts to gain thorough understanding of payment methodologies
Examine transplant claims and cases, and calculate reimbursement based on contract terms or other reimbursement methods, in order 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 company personnel
Direct claims to and coordinate and support specialty units
Attend client, department and company meetings
Comply with federal and state laws, company and department policies and procedures

Essential Skills and Experience:
Experience with Transplants in a claims, case management, clinical, or other related setting
High School diploma or equivalent
Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
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

Skills and Experience:
Minimum 3-years related experience and/or training
Related Professional License/Certification(s)
Associate or Bachelor's Degree(s)
Bottom Line Requirements:
1. Degree preferred.
2. 3 + years of experience with Transplants in a claims, case management, clinical, or other related setting.; Cincinnati, Ohio, United States; User's other ads

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