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Insurance Claims Analyst - Hilo

Company: On Time Talent Solutions
Location: Hilo
Posted on: May 12, 2022

Job Description:

Insurance Claims AnalystHilo, HawaiiAlso known as "The Big Island", Hilo is the largest island in the Hawaiian Islands and is home to rainforests, volcanoes and breathtaking state parks. Also, home to Hilo Medical Center and a variety of other nationally ranked healthcare clinics, the City of Hilo has different roles that can fit what you're looking for in your next role.On Time Talent Solutions is seeking Insurance Claims Analysts who will handle first and third party claims in a quality manner and meet our high standards of accuracy, efficiency, quality customer service and regulatory compliance.Insurance Claims Analyst Responsibilities:

  • Develop service line and physician level reimbursement analyses and models (involving multiple variables and assumptions) to support a variety of new/revised strategies, approaches, and provisions
  • Coordinate, compile, model and analyze the financial/cost impact of new and existing value based care provider contracts including global payment and risk-sharing arrangements
  • Refer finalized investigations to appropriate area such as Claims Ea, UW Examiner, Management, etc.
  • Work with various internal stakeholders to ensure timely and equitable resolution of claims In the event of an accident, injury or contract dispute
  • Assist in preparation and delivery of insurance and risk manuals and training programs for key stakeholders, as neededInsurance Claims Analyst Qualifications:
    • Bachelor's degree in business, risk management, insurance or related field
    • A comprehensive understanding of current episode payment methods used by CMS and by commercial payers, in addition to other complex reimbursement methodologies
    • Knowledge of hospital operations, health/insurance benefit plans, and revenue cycle claims systems
    • Working knowledge of ICD-9, CPT, HCPC coding and Medical Terminology
    • 5-7 years relevant experience in insurance and risk is required
    • Certification of Certified Risk Manager and/or other accreditations highly preferred

Keywords: On Time Talent Solutions, Hilo , Insurance Claims Analyst - Hilo, Professions , Hilo, Hawaii

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