Claims Analyst

Genesis Orthopedics & Sports Medicine

• Operations & Oversight
• Review and validate all contractual adjustments and ensure accuracy in claim posting and payer compliance
• Download and allocate new accounts to analysts from multiple EPIC workqueues based on payer, aging, and priority
• Audit processed claims for accuracy, completeness, and timeliness before submission or follow-up
• Perform quality checks and ensure analysts follow correct claim handling procedures
• Conduct daily and weekly performance reviews, tracking productivity and accuracy metrics
• Team Management
• Lead and support a team of claims analysts, providing guidance, performance feedback, and escalation support
• Review and summarize EOD (End of Day) and EOW (End of Week) reports to evaluate team output and resolve discrepancies
• Manage task assignments, track turnaround times, and balance workloads across analysts
• Provide training and corrective coaching when errors or trends are identified
• Claims & Denial Management
• Oversee denial trending and root cause analysis for all orthopedic-related claims
• Identify and escalate systemic issues such as incorrect coding, missing documentation, or payer configuration errors
• Work closely with billing, coding, and authorization teams to resolve high-value or high-impact claims
• Ensure claims are submitted, followed up, and appealed in accordance with payer guidelines and timely filing limits
• Analytics & Reporting
• Prepare and distribute daily, weekly, and monthly reports on claim status, denial trends, and AR performance
• Monitor KPIs such as denial rate, claim turnaround time, and first-pass resolution rate
• Track performance metrics for the entire team and provide data-driven recommendations for improvement
• Compliance & Continuous Improvement
• Ensure all claim activities comply with HIPAA, payer rules, and internal SOPs
• Stay current with orthopedic coding changes, payer updates, and EPIC workflows
• Recommend and implement process improvements to enhance claim accuracy and reduce rework
• Participate in audits and provide supporting claim documentation when required
  

Requirements

• 3-5 years of experience in medical claims management or billing, with a strong focus on orthopedic claims
• Proven experience managing or leading a claims or AR team in a healthcare setting
• Hands-on experience with EPIC system is required
• Excellent understanding of CPT/HCPCS codes, modifiers, EOBs, ERAs, CARC/RARC codes, and payer-specific denial handling
• Advanced Excel skills (pivot tables, lookups, trend tracking)
• Exceptional attention to detail and strong problem-solving abilities
• Excellent communication skills and ability to work cross-functionally with billing, coding, and management teams
  

Benefits

Why Choose Genesis?

Supportive Team

Competitive Compensation

Meaningful Impact

Apply today and be part of something truly transformative at Genesis Orthopedics & Sports Medicine.