Senior Claims Analyst
Job Summary
Experienced in hospital claims adjudication, the full-time remote Senior Claims Analyst will analyze hospital bills and claims data to identify billing errors and negotiate claim adjustments on behalf of ASO clients.
Key Responsibilities
- Perform detailed audits of hospital claims to validate billing accuracy and identify discrepancies
- Review high-cost claims to uncover overpayments and negotiate adjustments with claims administrators
- Analyze claims data to identify trends and maintain tracking logs of recovered savings
Required Qualifications
- Hospital/Surgical/ICU Nursing background (RN) with clinical coding experience
- 5+ years of experience in hospital claims analysis and payment integrity
- Strong knowledge of DRG methodology, UB-04 billing, and related coding systems
- Understanding of stop loss insurance and its implications for claim adjustments
- Experience negotiating with TPAs or insurance carriers on disputed claims
Complete Job Description
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