**Please note: This position is with Nova, a division of Independent Health Corporation (a subsidiary of Independent Health).**
The Claims Analyst is responsible for adjudicating and adjusting medical and/or dental claims against established criteria, and in accordance with specific clients SPD’s maintaining goals in accuracy levels of 99% and baseline productivity rates. The Claims Analyst is responsible to respond to client, member and/or provider inquiries on claim status, benefit designs and claim payments working in conjunction with the Customer Service Representatives. The Claims Analyst will be responsible to accurately identify and assess issues in both test and production environments and offer sound recommendations for resolution as required.
High School education or GED equivalent required; experience with Third Party Administrators (TPA) and/or ERISA plans preferred.
2+ years’ experience with claims processing or medical/dental billing required.
Knowledge of medical and/or dental billing procedures; ADA, CPT and ICD coding and medical terminology knowledge.
Solid PC and MS Office skills (Word and Excel) required.
Analytical skills for review of health care delivery against established criteria.
Understands the importance of maintaining the physical and technical security and privacy of protected health information (PHI).
Excellent verbal, written and interpersonal communication skills required
Ability to develop and maintain standard operating procedures, with demonstrated ability to utilize available resources without assistance.
Independent Health is an equal opportunity employer.