Claims Analyst - 992530

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Nova Southeastern University (NSU) was founded in 1964, and is a not-for-profit, independent university with a reputation for academic excellence and innovation. Nova Southeastern University offers competitive salaries, a comprehensive benefits package including tuition waiver, retirement plan, excellent medical and dental plans and much more. NSU cares about the health and welfare of its students, faculty, staff, and campus visitors and is a tobacco-free university.

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Primary Purpose:

Analyzes and manages healthcare claims to ensure accuracy and timely reimbursement. Reviews, processes, and resolves claims issues while ensuring compliance with payer guidelines and company policies.

 

Job Category: Non-Exempt

Hiring Range: 

Pay Basis:  Hourly

Subject to Grant Funding? No  

Essential Job Functions: 

1. Identifies and investigates claim denials and rejections.
2. Analyzes trends and patterns in claims data to identify potential issues or areas for improvement.
3. Develops and implements strategies to resolve issues and reduce the rate of denials. Prepares and submits appeals as necessary.
4. Generates reports to support decision-making and optimize the revenue cycle process.
5. Works closely with billing, coding, and patient financial services teams to address and resolve claims-related issues.
6. Facilitates communication between healthcare providers and payers.
7. Ensures compliance with healthcare regulations, payer policies, and company procedures.
8. Maintains accurate records of claims processing, including detailed notes on issues, resolutions, and follow-ups.
9. Maintains detailed records of collection activities, payment arrangements, and correspondence.
10. Monitors and manages assigned accounts, ensuring that all payments and adjustments are accurately recorded and applied.
11. Follows up on outstanding patient accounts and insurance claims through phone calls, emails, and written correspondence.
12. Performs other duties as assigned.
13. Completes special projects as assigned.

Job Requirements: 

Required Knowledge, Skills, & Abilities: Knowledge:
1. Proficient knowledge of MS Office Suite (Outlook, Word and Excel).
2. English Language - General knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
3. Customer and Personal Service - General knowledge of principles and processes for providing customer and personal services. This includes needs assessment, meeting quality standards for services, and evaluation of user satisfaction.
4. Proficient knowledge of payer policies and regulations, including Medicare, Medicaid, and private insurance guidelines.

Skills:
1. Active Listening - Proficient skills in giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
2. Speaking - Advanced skills in talking to others to convey information effectively.
3. Critical Thinking - Proficient skills in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
4. Reading Comprehension - Advanced understanding of written sentences and paragraphs in work-related documents.
5. Judgment and Decision Making - Proficient skills in considering the relative costs and benefits of potential actions to choose the appropriate one.
6. Writing - Advanced skills in communicating effectively in writing as appropriate for the needs of the audience.
7. Complex Problem Solving - Proficient skills in identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
8. Service Orientation - Proficient skills in actively looking for ways to help people.
9. Communication - Excellent verbal and written communication skills, with the ability to create engaging content.

Abilities:
1. Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
2. Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
3. Inductive Reasoning - The ability to combine pieces of information to form general rules or conclusions (including