Claims Analyst I

hace 2 semanas


San Juan, San Juan, Puerto Rico Mcs Healthcare Holdings, Llc A tiempo completo
Job Title: Claims Analyst I

Job Summary:

We are seeking a highly skilled Claims Analyst I to join our team at Mcs Healthcare Holdings, LLC. As a Claims Analyst I, you will be responsible for analyzing and processing simple or non-complex professional and institutional claims, ensuring accurate and timely adjudication of payments.

Key Responsibilities:

  • Analyze and process claims, including data entry, adjudication, and declining payments
  • Request additional information from claimants as needed
  • Receives, posts, records, and archives claims assigned to their work unit
  • Cancels claims that have been worked on in their work unit
  • Performs data entry of claims, referrals, and CHRA
  • Processes CMS-1500 and UB-04 claims according to established processing and time rules
  • Refers analyzed claims that require support from other departments
  • Maintains an applicable financial and processing accuracy as established in the current policy and procedure

Requirements:

  • Four-year high school diploma or equivalent
  • Minimum two (2) years of experience in data entry in a Provider Call Center in the health insurance industry or a medical billing course
  • OR
  • Two (2) years of university studies equivalent to 60 approved credits or an Associate's degree
  • Minimum of one (1) year of experience in data entry in a Provider Call Center in the health insurance industry or medical billing course

Language Skills:

Intermediate level in Spanish and English (writing, conversational, and comprehension)

Equal Employment Opportunity:

Mcs Healthcare Holdings, LLC is an equal opportunity employer and takes affirmative action to recruit women, minorities, protected veterans, and individuals with disabilities.


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