The Claims Processing Analyst ensures efficient processing of claims for hospital bills and/or professional fees with the objective of accurate adjudication and meeting the given turn-around-time, processing the appropriate prompt payment discounts and ensuring non-suspension of provider services.
Job Responsibilities:
- Process timely and accurately claims for hospital bills, Doctor's professional fees and meeting deadlines and hospital standards ensuring an uninterrupted health service to our members.
- Evaluate and process outpatient and in-patient claims.
- Coordinate with providers concerns with claims being processed
- Coordinate and collaborate concerns with other departments.
- Monitor status of claims from various hospitals
- Reconcile accounts with hospitals as needed and attend to provider's inquiries.