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Claims Analyst - Healthcare -Hopfer-Tucson in Tucson, AZ at NextGen

Date Posted: 10/25/2018

Job Snapshot

  • Employee Type:
  • Location:
    Tucson, AZ
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Claims Analyst

Position Purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.

  • Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims.
  • Research and determine status of medical related claims
  • Review charges, access the computer system and use payment or denial codes within established department guidelines and standards
  • Clarify health insurance coverage for coordination of benefits to process claims
  • Maintain records, files, and documentation as appropriate
  • Meet department production and quality standards

Number of openings: 64

Anticipated Start Date: 11/19

Contingent to hire after 520 hrs

Top Skillsets: General computer skills, ability to work in production environment with KPIs, healthcare knowledge in claims or billing is a plus

Education/Experience: High school diploma or equivalent. 1+ years of claims processing, medical billing, administrative, customer service, call center, or physician's office or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred.


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