Coordinator-Claims Analyst-Repricing and Extended functions

As a Medical Claims Analyst, your role involves verifying that all necessary clinical documentation is included to support claim submissions and medical necessity. You will be responsible for identifying and resolving inconsistencies, errors, or missing documentation in patient records or claims. Prioritizing and managing workloads to ensure expedited and high-priority cases are processed within defined timelines is a key aspect of your responsibilities. Your key responsibilities will include: - Verifying the inclusion of all necessary clinical documentation for claim submissions - Identifying and resolving inconsistencies, errors, or missing documentation in patient records or claims - Prioritizing and managing workloads to ensure timely processing of high-priority cases - Collaborating with healthcare providers, coders, and billing staff to obtain or clarify necessary information - Ensuring compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing - Preparing accurate reports and summaries of claim findings, trends, and potential process improvements - Supporting internal audits and quality assurance initiatives by providing detailed documentation and analytical insights - Maintaining a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures In addition to the above responsibilities, it is important for you to have a good understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures. Your role will also involve collaborating with healthcare providers, coders, and billing staff to ensure accurate and timely processing of claims. Please note that the company values compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing. By ensuring accurate and detailed documentation, you will support internal audits and quality assurance initiatives, contributing to the overall efficiency and effectiveness of the claims processing workflow.,