Claims Analyst

Claims Analyst

JOB OVERVIEW:

The Claims Analyst is responsible for analyzing, appealing, and resolving denied or underpaid medical insurance claims to ensure accurate reimbursement for healthcare services. This role requires a deep understanding of payer requirements, billing codes, and denial management processes to identify root causes and prevent future denials.

JOB DUTIES:

• Review and research denied or underpaid claims from insurance carriers, identifying denial trends and root causes.
• Prepare and submit timely and accurate appeals with supporting medical documentation and payer guidelines.
• Communicate effectively with insurance companies to follow up on outstanding denials and appeal status.
• Collaborate with billing, coding, and client account teams to resolve discrepancies and ensure claim accuracy.
• Update claim activity notes in the system and maintain detailed documentation of actions taken.
• Identify patterns or systemic issues contributing to denials and report findings to leadership for process improvement.
• Ensure compliance with federal, state, and payer regulations (HIPAA, Medicare, Medicaid, etc.).
• Meet or exceed productivity and quality standards established by the RCM department.
• Participate in ongoing training to stay updated on payer policies, billing regulations, and denial trends.
• Review and research denied or underpaid claims from insurance carriers, identifying denial trends and root causes.
• Prepare and submit timely and accurate appeals with supporting medical documentation and payer guidelines.
• Communicate effectively with insurance companies to follow up on outstanding denials and appeal status.
• Collaborate with billing, coding, and client account teams to resolve discrepancies and ensure claim accuracy.
• Update claim activity notes in the system and maintain detailed documentation of actions taken.
• Identify patterns or systemic issues contributing to denials and report findings to leadership for process improvement.
• Ensure compliance with federal, state, and payer regulations (HIPAA, Medicare, Medicaid, etc.).
• Meet or exceed productivity and quality standards established by the RCM department.
• Participate in ongoing training to stay updated on payer policies, billing regulations, and denial trends.

REPORTING RELATIONSHIPS:

• This position works under general supervision, according to established procedures; decides how and when to complete tasks, and reports major activities through periodic meetings and written reports.
• This position reports directly to the RCM Manager. 

JOB REQUIRMENTS:

· High school diploma required; bachelor’s degree preferred.

· Minimum of 3 years of experience working with hospital claim denials.

· Strong analytical and problem-solving skills.

· Excellent written and verbal communication skills.

· Ability to multitask while maintaining strong attention to detail.

· Ability to work under pressure and meet tight deadlines.

· Intermediate proficiency in Microsoft Office (Excel, Word, Outlook).

· Must obtain and maintain the HBIZ Denial Recovery Specialist Certification.

Health Business Solutions (HBiz) is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.

HBiz complies with all applicable employment laws for rem