Under the general direction of the Director of Business Services, the Hospital Claims Analyst will perform accurate and timely filing of initial and secondary insurance claims, follow up on unpaid claims to assure payment to the hospital and affiliated entities, maintaining adequate cash flow and accounts receivable balance in compliance with TJC, federal, state, and local guidelines, and organizational policies. The role requires communication with medical staff, other departments, and external agencies while maintaining confidentiality and operating semi-autonomously in a fast-paced environment.

Responsibilities include processing and adjusting inpatient and outpatient medical claims to meet quality and production standards; researching claim status and discrepancies; resolving errors and audit findings; ensuring claims validity through documentation review; analyzing claim patterns for errors and necessary process modifications; documenting root cause analyses with recommended solutions; responding to claim inquiries; improving workflow and organizational structure; maintaining procedural documentation; supporting financial, regulatory, and operational standards; providing detailed reporting; enhancing subrogation recovery efforts; assisting with customer feedback and best practice identification; handling PHI in compliance with HIPAA standards; demonstrating proficiency with all realms of insurance billing (managed care, commercial, hospital billing formats including UB-04 and 1500 forms); reviewing accounts receivable for insurance financial classification, denied claims, contractual disputes, and adjustments; processing patient refunds; and participating in continuing education and safety standards adherence.

Hours: Monday - Friday, 8:30am - 5:00pm.