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Sr/Jr Claims Analyst

Keywords / Skills : "US Health care", Claims Processing, "Payment validation"

1 - 3 years
Posted: 2019-03-29

Health Care
Other Health Care/ Hospitals - Claims analyst
Any graduate
Posted On
29th Mar 2019
Job Description
Greetings from Vibrant HR Team...

We have immediate vacancies for Claims Analyst & Sr Claims Analyst in US Healthcare.

Designation : Claims Analyst & Sr Claims Analyst

Domain : US Healthcare Payer 

Experience : 1.5 Years +

Work Location : Hyderabad 

CTC : Upto 4 L (Depends on Current CTC & Performance )

Job Description: 
  • Retrospective claim review & analysis to verify payment accuracy and identify incorrect claim reimbursements
  • Payer-Provider Contract compliance analysis & assessment of claims for payment integrity, in accordance with the terms of the agreement
  • Identification and correction of contract management issues, providing critical insights into the complex payer contracts affecting the provider reimbursement.
  • Identify billing & coding inconsistencies resulting in denials/incorrect payments, and take measures to rectify these retroactively
  • Research & analyze facility (UB-04) claims for possible payment variances, and take corrective action to receive the appropriate claim reimbursement
  • Identify & validate the payment variance and re-file/appeal the claims
  • Should have Experience into over payment and payment validation
  • Follow up with Insurance companies on behalf of hospitals on the potential underpayments
  • Recover the underpaid amount on behalf of the provider
  • Stay abreast of Medicare, Medicaid & Commercial insurers billing, coding & payment guidelines

Desired Candidate Profile:

US Healthcare experience on at least one of the following is a pre-requisite 
  • Facility Claims adjudication experience of at least 1 years
  • Facility claims AR/Denial analysis experience for a period of 18 months
  • Over payment identification & recovery experience of 12-18 months
  • Contract review experience
  • Contract/member benefits modeling experience
  • Credit balancing experience
  • Healthcare Claims Audit & analysis
  • Good knowledge on Medicaid and Medicare payment methodologies
  • Expertise to understand payer remittance advice(RA)/ Explanation of benefits(EOB)
  • Expertise to understand payer contract to validate payments
  • Knowledge on resolving payer denials(Medicare, Medicaid & Commercial)
  • An inclination to research, analyze & investigate
  • Ability to think beyond transaction/guidelines based activities, and aspire for high-end audit & analytical activities
  • To review the appeals and grievances
Interested candidates Can forward their updated resumes to [HIDDEN TEXT] or contact - 9343075322

Thanks & Regards
HR Executive

About Company


Vibrant HR Consultancy Services is a professional recruitment firm catering to the needs of various companies across verticals. Vibrant is based out of Bangalore & services clients across India. Since our inception, we have been in the business scenario with a mission of serving the companies with the speed and quality that is required.
About Recruiter
Sukanya VS
HR Executive
Vibrant Hr Consultancy
Vibrant HR is a Bangalore based Human Resource Sourcing and Staffing ...
Skills I hire for IT , Healthcare , BPO ,Legal
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