Insurance Claims Analyst (Full-time, Monday - Friday, 8:00am-4:30pm)

Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for five consecutive years by U.S. News & World Report. We employ 3,200+ team members and serve the region with over 40 clinic locations, the region's only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary

The role of the Insurance Claims Analyst reports to the assigned Insurance Billing Manager. This position reviews, processes, and analyzes medical insurance claims for accuracy and compliance with policies, investigating discrepancies and ensuring timely payments to providers. This position is responsible for verifying patient information, checking for coding errors (like ICD-10 and CPT), effectively and efficiently communicating with healthcare providers and internal departments, and maintaining detailed records. This position requires strong analytical and problem-solving skills, a keen eye for detail, and familiarity with medical billing and claims management software.

Essential Position Responsibilities

• Analyze insurance claims to ensure accuracy, completeness, and compliance with policy guidelines.
• Verify patient information and check for errors in billing and coding.
• Investigate and resolve discrepancies, such as claim denials or billing issues, by communicating with providers and internal departments.
• Provide timely and efficient follow-up on all outstanding AR using assigned ATB worklist reports, using various systems, including Payor portals, Payor phone inquiries and/or written communications
• Ensure claims are processed efficiently and that reimbursements are paid correctly and on time.
• Apply knowledge of healthcare industry policies, regulations, and medical billing codes (like ICD-10 and CPT) to ensure correct billing practices.
• Maintain detailed records of claims and prepare reports on claims data, trends, and financial performance
• Maintain AR collection of claims at less than 30 days of account age
• Serve as a liaison with healthcare providers, patients, and internal departments to answer questions and resolve issues.

Qualifications

• Education: High School graduate or GED
• Licensure and Certifications: N/A
• Experience:
• Previous billing and claims experience within a hospital and/or clinic business office with 2+ year experience, preferred.
• Basic working knowledge of the MS Office suite of software, and the ability to operate standard office equipment.
• Broad knowledge of medical terminology, medical collections, MS-DRG coding methodology, ICD-10 and CPT coding, preferred.

Work Environment: This position will spend 80% of time sitting while performing work in a standard office environment and 20% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs.

Notice: This job description is designed to provide an overview of the essential and principal duties and responsibilities of the position. The job description is not designed or intended to cover or set forth a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Washington Regional reserves the right in its absolute discretion to change duties, responsibilities or activities or assign new duties, responsibilities, or activities at any time with or without notice. Employees may be directed to perform job-related tasks other than those specifically presented in this description.