Claims Analyst I
Research Data Group Inc
816 Roanoke Blvd, Salem, VA 24153
$50,000 - $80,000 a year - Full-time
Profile insights Find out how your skills align with the job description
Licenses Do you have a valid RN License license?
Yes No
Certifications Do you have a valid Certified Professional Coder certification?
Yes No
Skills Do you have experience in Research ?
Yes No
 
Job details Here’s how the job details align with your profile .
Pay • $50,000 - $80,000 a year
Job type • Full-time
 
Location 816 Roanoke Blvd, Salem, VA 24153
 
Full job description
Our company is growing! We are seeking a Compliance Analyst with knowledge in the healthcare field.
• Research Data Group’s Beacon HCI division is designed to save corporate healthcare payers millions of dollars utilizing a proprietary software tool developed with years of research and knowledge of Federal Billing Guidelines and Regulations in the healthcare industry.
This position is responsible for performing compliance reviews and appeals as relates to compliance reviews and research as necessary to determine the accuracy and appeals of the charges billed by facilities. This position will consult with the EVP of Production System, Manager of Claims Analysts and Senior Resolution Specialist. This position will assist with any special projects and/or development of edits to the Hospital Software Program.
LOCAL CANDIDATES ONLY POSITION IS FULL TIME IN OFFICE
Compliance Analysis and Appeal review
• Receives, investigates, and responds to appeals from hospitals.
• Research and obtain appropriate documentation to support the appeal.
• Review of UB04 and detailed itemized statements
• Review of automated system analysis
• Perform hospital coding analysis. e.g. Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes.
• Review procedure/facility codes for unbundling, MUE’s, multiple procedures, inpatient codes on outpatient bills, routine services, etc.
• Review of UB04 and detailed itemized statements
• Assist in Internal Code Creation
• Attend required staff training and meetings.
• Other special projects as needed.
Medical Review and Pricing Analysis
o Review medical record documentation as relates to the UB04 and itemized statement
o Identify compliance and billing errors as well as make appropriate documentation as relates to review performed
o Obtain hospital CMS certification information
KNOWLEDGE, SKILLS & ABILITIES
• Two-year experience in Microsoft Office and Excel programs
• Proficient data entry skills and accuracy
• Ability to follow procedures.
• Comprehension of hospital coding, billing guidelines and regulations, to include but not limited to, Medicare guidelines, application of Health Insurance Policies, and current industry standards.
• Exceptional attention to detail
• Excellent organizational, analytical, and problem-solving skill
• Capable of handling multiple projects in a fast-paced, hyper-growth environment
• Strong interpersonal and team-building skills
Experience and Training
• 1-2 years’ experience as LPN or RN preferred.
• Certified Professional Coder (CPC), (CPMA) (preferred but not required)
• One or more years of experience working with healthcare claims that demonstrate expertise in ICD 9/10 Coding, HCPCS/CPT Coding, DRG and medical billing for an Insurance company and/or hospital.
• One or more years of experience performing medical record reviews is required.
• Medical Terminology
• Problem-solving skills to research and resolve discrepancies, denials, appeals.
• Medicare Appeals processing background. (Preferred)
• RAC Audit experience (Preferred but not required)
• Knowledge of Medical fraud/abuse healthcare laws (Preferred but not required)
• Rev cycle management (Preferred)
 
Our company is growing! We are seeking a Compliance Analyst with knowledge in the healthcare field.
• Research Data Group’s Beacon HCI division is designed to save corporate healthcare payers millions of dollars utilizing a proprietary software tool developed with years of research and knowledge of Federal Billing Guidelines and Regulations in the healthcare industry.
This position is responsible for performing compliance reviews and appeals as relates to compliance reviews and research as necessary to determine the accuracy and appeals of the charges billed by facilities. This position will consult with the EVP of Production System, Manager of Claims Analysts and Senior Resolution Specialist. This position will assist with any special projects and/or development of edits to the Hospital Software Program.
LOCAL CANDIDATES ONLY POSITION IS FULL TIME IN OFFICE
Compliance Analysis and Appeal review
• Receives, investigates, and responds to appeals from hospitals.
• Research and obtain appropriate documentation to support the appeal.
• Review of UB04 and detailed itemized statements
• Review of automated system analysis
• Perform hospital coding analysis. e.g. Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes.
• Review procedure/facility codes for unbundling, MUE’s, multiple procedures, inpatient codes on outpatient bills, routine services, etc.
• Review of UB04 and detailed itemized statements
• Assist in Internal Code Creation
• Attend required staff training and meetings.
• Other special projects as needed.
Medical Review and Pricing Analysis
o Review medical record documentation as relates to the UB04 and itemized statement
o Identify compliance and billing errors as well as make appropriate documentation as relates to review performed
o Obtain hospital CMS certification information
KNOWLEDGE, SKILLS & ABILITIES
• Two-year experience in Microsoft Office and Excel programs
• Proficient data entry skills and accuracy
• Ability to follow procedures.
• Comprehension of hospital coding, billing guidelines and regulations, to include but not limited to, Medicare guidelines, application of Health Insurance Policies, and current industry standards.
• Exceptional attention to detail
• Excellent organizational, analytical, and problem-solving skill
• Capable of handling multiple projects in a fast-paced, hyper-growth environment
• Strong interpersonal and team-building skills
Experience and Training
• 1-2 years’ experience as LPN or RN preferred.
• Certified Professional Coder (CPC), (CPMA) (preferred but not required)
• One or more years of experience working with healthcare claims that demonstrate expertise in ICD 9/10 Coding, HCPCS/CPT Coding, DRG and medical billing for an Insurance company and/or hospital.
• One or more years of experience performing medical record reviews is required.
• Medical Terminology
• Problem-solving skills to research and resolve discrepancies, denials, appeals.
• Medicare Appeals processing background. (Preferred)
• RAC Audit experience (Preferred but not required)
• Knowledge of Medical fraud/abuse healthcare laws (Preferred but not required)
• Rev cycle management (Preferred)