The Medical Claims Analyst is responsible for collections, account follow-up, billing, and allowance posting for assigned accounts. The role ensures accurate, timely resolution of outstanding claims through proactive follow-up and analytical problem-solving.

Duties and Responsibilities

• Follow up with payers via phone, email, fax, or payer portals to ensure timely resolution of outstanding claims.
• Meet and maintain daily productivity and quality standards.
• Use workflow systems, client host systems, and other tools to collect payments and resolve accounts.
• Adhere to all client and team policies and procedures.
• Maintain knowledge of timely filing deadlines for designated payers.
• Research payer-specific billing guidelines as needed.
• Analyze and resolve issues causing payer payment delays.
• Identify trends in claim issues to proactively reduce denials.
• Communicate identified issues and trends to management.
• Initiate and process appeals when necessary.
• Identify and correct medical billing errors.
• Prepare and send accurate appeal documentation and supporting records.
• Understand underpayments, overpayments, and credit balance processes.
• Assist with special A/R projects as needed; strong analytical and communication skills required.
• Maintain cooperative and courteous communication with patients, visitors, coworkers, management, and clients.
• Protect and handle PHI in accordance with HIPAA standards.
• Work independently using assigned work queues.
• Maintain confidentiality and professionalism at all times.
• Perform other duties as assigned by management.

Qualifications

• Completed at least High School education.
• Minimum of 1 year of Healthcare Accounts Receivable/Collections experience in a BPO environment (claims payment processing, status/tracking, medical billing, AR follow-ups, denials, appeals).
• Experience in medical billing and AR collections.
• Background in calling insurance payers to verify claim status and resolve payment disputes.
• Must be willing to work night shifts.

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