The Claims Analyst is responsible for the completion of medical bill reviews. This position utilizes the system database to determine the reasonable cost of medical care within a specific geographic area and manually reviews for reasonableness, rarity, duration, application of proper fee schedule, accurate diagnosis and CPT coding, bundling/unbundling, drugs, supply coding, and duplicate billing. This position ensuresreviews are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.
ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:
EDUCATION AND/OR EXPERIENCE
High school diploma or equivalent required. Minimum one year clerical experience; or equivalent combination of education and experience required. Experience in a medical office or insurance industry with knowledge and experience utilizing ICD9, CPT coding and Medical Terminology preferred.