OMNISTAR

Claims Analyst

Application Deadline:

Application Deadline:

Summary

Experience:

10 Years

Location:

New Jersey

Published:

03/14/2023

Salary:

90K

Requirements:

Overview:
As a Medical Claims Analyst, you will play a vital role in ensuring the accuracy and efficiency of medical claims processing within our organization. Your responsibilities will include reviewing and analyzing medical claims for completeness, accuracy, and compliance with regulations. You will collaborate with various stakeholders, including healthcare providers, insurance companies, and internal teams, to resolve any discrepancies and facilitate timely claims adjudication. This position requires attention to detail, analytical skills, and a thorough understanding of medical billing procedures and healthcare regulations.

Responsibilities:

Claims Review: Thoroughly examine medical claims submitted by healthcare providers to identify errors, discrepancies, or incomplete information.

Verification: Validate the accuracy of patient demographics, insurance information, procedures, diagnoses, and other claim details against relevant documentation and databases.

Coding Analysis: Ensure proper coding of medical procedures and diagnoses according to industry standards (e.g., ICD-10, CPT, HCPCS) and verify coding compliance with regulatory requirements.

Documentation Assessment: Evaluate medical records, invoices, and other supporting documentation to substantiate the necessity and appropriateness of billed services.

Adjudication Support: Collaborate with insurance carriers, healthcare providers, and internal teams to resolve claim issues, clarify discrepancies, and expedite the claims adjudication process.

Responsibilities & Context:

Qualifications:

Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field.

Certified Professional Coder (CPC) credential preferred.

Previous experience in medical claims processing, healthcare billing, or insurance claims administration.

Proficiency in medical coding systems (e.g., ICD-10, CPT, HCPCS) and knowledge of healthcare reimbursement methodologies.

Strong analytical skills with the ability to interpret complex medical documentation and identify discrepancies.

Excellent communication skills, both written and verbal, for effective interaction with internal and external stakeholders.

OMNISTAR EEO:

The equal employment opportunity policy of the OMNISTAR Solutions LLC., provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. OMNISTAR Solutions LLC., hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
OMNISTAR Solutions LLC. does not tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants

Workplace:

Employment Status:

FullTime

Job Location:

New Jersey