Medical Claims Analyst (Examiner) Hi-Tech Healthcare Plano, TX 75093

Job Title:

Medical Claims Analyst The Role:

As a Medical Claims Analyst at Hi-Tech Health, you will play a critical role in processing medical claims by verifying and updating claim information, ensuring compliance with federal regulations, and determining reimbursement. You will apply your expertise to provide billing analyses and support the accurate adjudication of claims, contributing to the efficiency and effectiveness of our claims administration systems.

About Hi-Tech Health:

Hi-Tech Health has been a pioneer in building turnkey claims administration systems since 1990. We serve a wide range of clients, including Third Party Administrators, Insurance Carriers, and Provider Sponsored Health and Medical Plans. Our customizable platform is designed to meet the unique needs of any payer, ensuring swift implementation without the need for outside consultants. We pride ourselves on our long-standing relationships with clients, from start-ups to established organizations, delivering tailored solutions for adjudication, reporting, and plan management.

Job Duties:

Primary Responsibilities:

Process medical claims in the Healthcare Industry, including major medical, supplemental, and ancillary plans. Provide expertise and general support by reviewing, researching, investigating, negotiating, processing, and adjusting hospital and physician claims. Consistently meet established productivity, schedule adherence, and quality standards. Utilize knowledge of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. Answer phone calls regarding claims questions as needed. Adhere to privacy and confidentiality policies (HIPAA). Perform data entry and coding. Prepare documents and reprice bills according to physician/facility contracts. Accurately scan all claims. Effectively communicate and work as part of a team. Navigate across various computer systems to locate critical information. Thoroughly review, analyze, and research complex healthcare claims to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. Attention to detail is critical to ensure the timely and accurate processing of claims.

Qualifications:

Minimum High School Diploma. 5+ years of experience in healthcare claims analysis (adjudicating claims). Familiarity with computer and Windows PC applications, with the ability to learn new and complex systems. Proficiency in Excel for creating and maintaining spreadsheets and Word for documentation. Experience managing emails using Microsoft Office. Ability to multi-task and understand multiple products and levels of benefits. Extended periods of sitting at a computer with keyboard/mouse use. Ability to pass a preliminary credit and background check. U.S. Citizenship required.

Work Location:

Hi-Tech Health Office, Plano, Texas. Reliable commute or relocation to Plano, TX before starting work is required. If you meet the qualifications and are interested in joining a dynamic team dedicated to enhancing healthcare claims processing, we encourage you to apply.

Job Type:

Full-time Pay:

$50,000.00 - $60,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Schedule:

8 hour shift Monday to

Friday Experience:

Healthcare claims analysis: 5 years (Required) ICD coding: 1 year (Required) CPT coding: 1 year (Required)

Healthcare Medical Claim Processing:

1 year (Required) Ability to

Commute:

Plano, TX 75093 (Required)

Work Location:

In person