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Claims Financial Analyst

Accounting and Finance | Miami, FL | Full Time

Job Description

About Us:

We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.  This is a healthcare position, please do not apply if you have no healthcare responsibility.

Responsibilities:

 

  • Experienced claims analyst, claims examiner to process remittance advices for "UB-04" and "CMS 1500", and reconcile the correct payments received and processed correctly.
  • Must have extensive knowledge of hospital and physician billing and collections, knowledge of Medicare, Medicaid, Commercial and PPO claims processing a must
  • Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance and out of pocket amounts
  • Must be able to handle excel reconciliations and payment requests from networks, clients as well as invoicing clients for funding of medical claims to be paid,
  • Hospital coding and  UB 04, Correct Coding Initiative principles very helpful
  • Fully computer literate in use of Microsoft programs (word, excel, outlook and other every day office support software.  Must be proficient with the use of telephone in dealing with customers, providers and members.
  • Medicare Advantage plans, capitation plans,risk assessment process and payments helpful
  • Full Excel capabilities in managing and analysis data from excel, as well as the ability to understand the posting of payments received from insurance companies and payments to be made to providers
  • Full capabilities in the use of the English language, written, verbal and via telephone communications a must

Requirements:

  • Must have experience in medical claims processing and adjudication, self motivated, responsible, and with a desire for advancement.  An individual that has worked in a healthcare setting, billing service, doctors practice or other type of medical entity whereby they have process payments, remittance, have posted adjustments to processed claims and have reconciled payments received from an insurer may have the right experience and base to learn this job.  Must be punctual, responsible, with attention to detail and dependable.

Bonus Points:

  • PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry.
  • PayerFusion provides competitive benefits that include vacation, holiday, sick-time as well as health insurance and other corporate benefits.