JOB SUMMARY: The Claims Analyst is responsible for processing professional, inpatient, and outpatient facility claims using the knowledge of industry standard practices for processing medical claims. This position will also perform updates based on COB status, eligibility reinstatements, and retro-authorization approvals. This position applies relevant rules and regulations specific to coding, providers, plan benefits, contracts, state, and federal guidelines, as well as Community Health Choice?s policies and procedures. This position should possess and demonstrate Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness, and caring service.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: High School Diploma, GED or Equivalent.

2. Work Experience (Years and Area): 2 - 4 years relevant experience to include: One (1) year In-house healthcare claims operations experience and/or Two (2) years healthcare claims operations experience.

3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook)

5. Other Requirements: Working knowledge of medical procedures and terminology; Procedure Coding; analytical problem solving.
Basic knowledge of claims software usage.
Ability to speak, listen and write effectively.
Quick learner with the ability to adjudicate professional and facility claims, applying appropriate reimbursement methodologies.
Ability to problem solve and work independently.
Basic knowledge of claims software usage.


SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Writing /Composing (Correspondence / Reports )

2. Other Skills:
Analytical
Mathematics
Medical Terminology
Research
MS Word

3. Advanced Education: N/A

4. Work Schedule: Flexible

RESPONSIBLE TO: Supervisor/Manager

EMPLOYEE SUPERVISED: None