Insurance Analyst

TITLE: Insurance Analyst

POSITION PURPOSE/FUNCTION:

• Reduce accounts receivable to cash
• Identify and resolve insurance claim denials
• Identify and communicate reimbursement and billing system problems to the regional supervisor

RESPONSIBILITIES:

Primary Functions:

• Accurately and timely work the following to obtain resolution of patient accounts:

o   Insurance carrier Appeal

o   Insurance carrier No Response

o   Review Estimated Payment Report (EPR)

o   Creation of adjudication reports based upon EPR

o   Insurance carrier Correspondence

• Identify and report to Regional Supervisor payer trends affecting cash flow
• Prepare appeals relating to coding, provider enrollment, and payment processing issues.  
• Understand payer Explanation of Benefits (EOBs) and identify posting errors with    payments and adjustments.
• Read and understand rules and regulations pertaining to government and commercial payers within assigned state(s).
• Maintain production standard according to department guidelines on a weekly basis.
• Maintain income analysis standard according to department guidelines on a monthly basis.
• Maintain quality standards of 96% on QA quality audits.

QUALIFICATIONS:

Educational and/or Professional Qualifications:

• High school diploma or GED
• One to three years experience in resolving medical insurance denials, with an understanding of the overall billing process from data entry through final adjudication of the patient account.

Computer Application Skills:

• Proficient in the following: Word, Excel, Windows, Outlook, Internet

Other Special Training/Skills:

• Excellent written and oral communication skills.