Deskripsi Pekerjaan
Join Sales Rain BPO Inc. as a Claims Analyst - Post Pay Audit and become a crucial guardian of healthcare revenue integrity. In this dynamic role, you'll meticulously analyze denied medical claims to uncover root causes such as coding discrepancies, insufficient documentation, medical necessity gaps, and eligibility violations. Your expertise will directly impact revenue recovery rates while ensuring compliance with industry regulations. This position offers an opportunity to develop specialized skills in healthcare billing operations, regulatory frameworks, and denial prevention strategies. You'll collaborate with multidisciplinary teams to implement corrective actions and optimize claim processing workflows. Perfect for detail-oriented professionals seeking growth in the healthcare insurance sector, this role combines analytical rigor with meaningful impact on patient care financial outcomes.
Tanggung Jawab
- Conduct comprehensive reviews of denied medical claims to identify denial reasons including coding errors, missing documentation, medical necessity issues, and eligibility problems
- Analyze claim documentation against regulatory standards (ICD-10, CPT, HCPCS) to ensure accuracy and compliance
- Prepare detailed reports on denial trends, root cause analysis, and recommended corrective actions
- Collaborate with healthcare providers and internal teams to resolve claim discrepancies and gather necessary information
- Support appeals processes by providing documentation evidence and denial justification analysis
- Monitor claim processing systems to identify systemic issues and propose process improvements
- Stay updated on healthcare insurance regulations, coding guidelines, and industry best practices
Kualifikasi
- Bachelor's degree in Health Administration, Nursing, Business Administration, or related field
- Minimum 1-2 years of experience in medical claims processing, denial management, or healthcare billing
- Proficiency in medical coding systems (ICD-10, CPT, HCPCS) and billing procedures
- Strong analytical skills with ability to interpret complex claim data and documentation
- Excellent written and verbal communication skills for stakeholder interactions
- Attention to detail with high accuracy in reviewing financial and medical documentation
- Familiarity with healthcare insurance regulations (HIPAA, PHI) and compliance standards
- Proficient in Microsoft Office Suite and claims management software systems