Medical Claims Analyst

Job PurposeThe Medical Claims Analyst is responsible for collections, account follow-up, billing, and allowance posting for assigned accounts. The role ensures accurate, timely resolution of outstanding claims through proactive follow-up and analytical problem-solving.Duties and ResponsibilitiesFollow up with payers via phone, email, fax, or payer portals to ensure timely resolution of outstanding claims.Meet and maintain daily productivity and quality standards.Use workflow systems, client host systems, and other tools to collect payments and resolve accounts.Adhere to all client and team policies and procedures.Maintain knowledge of timely filing deadlines for designated payers.Research payer-specific billing guidelines as needed.Analyze and resolve issues causing payer payment delays.Identify trends in claim issues to proactively reduce denials.Communicate identified issues and trends to management.Initiate and process appeals when necessary.Identify and correct medical billing errors.Prepare and send accurate appeal documentation and supporting records.Understand underpayments, overpayments, and credit balance processes.Assist with special A/R projects as needed; strong analytical and communication skills required.Maintain cooperative and courteous communication with patients, visitors, coworkers, management, and clients.Protect and handle PHI in accordance with HIPAA standards.Work independently using assigned work queues.Maintain confidentiality and professionalism at all times.Perform other duties as assigned by management.QualificationsCompleted at least High School education.Minimum of 1 year of Healthcare Accounts Receivable/Collections experience in a BPO environment (claims payment processing, status/tracking, medical billing, AR follow-ups, denials, appeals).Experience in medical billing and AR collections.Background in calling insurance payers to verify claim status and resolve payment disputes.Must be willing to work night shifts.