Claims Analytics Analyst

Profile

Claims Analytics Analyst

The candidate will accurately and efficiently review contracts, research healthcare provider claims and big data analytics including performing detailed quantitative analysis to draw conclusions and develop meaningful insights, thoroughly documenting the investigation results and identifying and implementing appropriate and effective resolution strategies. Prioritize voluminous claim review workload. Validate claim status, claim liability and availability of coverage. Understand concepts of coverage, contract interpretation and reimbursement methodologies needed to analyze claims. Research and analyze information including employing advanced health care analytics and data science techniques to diagnose reimbursement issues, opportunities assessment, claim trends, develop solutions and initiate appropriate claim resolution strategies. Maintain quality and productivity standards as set by Management. Coordinate requests for analysis from internal and external clients including assignment, mentoring and establishing timelines. Influence others using a positive approach. Work independently with minimal supervision. Perform special projects as requested. Ensure compliance with Health Insurance Portability and Accountability Act. Mentor junior staff. Other duties as assigned. Should have 5+ years of position specific related revenue cycle and big data analytics work experience (managed care, data mining and/or legal). Experience with Microsoft Office products; experience with healthcare provider claims management software is highly preferred.

Additional Information

Send cover letter, salary requirements and resume.

Company info

Helton Law Group
1590 Corporate Drive
Costa Mesa
California
United States 92626
Website : http://www.heltonlawgroup.com