Medical Claims Analyst

6 Degrees Health Inc in Hillsboro, OR

  • Industry: Healthcare - Allied Health - Others
  • Type: Full Time
position filled

Company Overview

6 Degrees Health is bringing equity and fairness back to healthcare reimbursement by utilizing data and technology, including our own software platforms. Our team of industry experts work with health plans to make the most of their healthcare dollars, which allows them to pass along the savings back to their members. With positive change comes growth, so we are currently seeking Patient Support Specialists to join our fun, fast-paced office in the Hillsboro area.

Job Summary

Due to the anticipated growth, 6 Degrees Health is looking for the right candidate to join our team as a Medical Claims Analyst at our Hillsboro, OR location. This position acts as an intermediary between 6 Degrees Health and the claims teams at both providers and our clients. The ideal candidate will be detail oriented, organized and provide world-class customer service.

Responsibilities and Duties

  •  Support a culture that is consistent with 6 Degrees Health values and beliefs.
  •  Analyze medical claims to ensure proper coding
  •  Reprice claims according to contracted hospital payment schedules
  •  Reprice claims to Medicare reimbursement, both manually and software-aided
  •  Monitor incoming and outgoing electronic claims via our internal processing system
  •  Provide detailed reporting on claims volume, billed charges, savings, etc.
  •  Work with hospitals and customers to resolve claim issues with superior customer service
  •  Clearly document claims process and issue resolution
  •  Work collaboratively with the Claims Team to identify process gaps and improve procedures
  •  Maintain up to date healthcare industry policies and regulations
  •  Other responsibilities or projects as assigned
  • Qualifications and Skills

    Education:

  • High School Diploma or equivalent
  • AHIMA or AAPC certification preferred, but not mandatory
  • Experience:

  • 2 years of medical billing or coding experience required
  • Knowledge of Medicare coding and reimbursement regulations preferred
  • 2 years customer service experience required
  • Special Skills:

  • Excellent project and time management skills.
  • Proven organizational and prioritization skills with an ability to operate in ambiguous situations
  • Demonstrates ability to quickly learn adapt new ideas and processes
  • Ability to maintain accuracy and efficiency standards consistently
  • Ability to effectively adapt in a dynamic environment
  •  Mental:

  • Must have the ability to read and understand various procedural documentation.
  • Ability to interpret patient records and calculations while maintaining a strong attention to detail.
  • Strong internal and external communication skills, both verbal and written.
  • Must be able to manage inbound calls with confidence and compassion.
  • Physical:

  • Must have the ability to lift over 20 lbs during a scheduled work shift.
  • Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary.
  • Must be able to sit or stand for two hours at a time.
  • Equipment Used:

  • Must be able to operate computers and phones to support position requirements.
  • Strong Microsoft Office Skills a must, Apple product proficiency preferred.
  • Benefits and Perks

  • Competitive Salary + Bonus
  • Medical, Dental, Vision and Other Outstanding Ancillary Benefits
  • Training and Development Opportunities
  • Paid Holidays
  • Unlimited Paid Time Off

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