As part of the Revenue Cycle, the Claims Analyst is responsible for monitoring claims from start to finish, verifying and updating information on claims, reviewing the accounts for appropriate reimbursement, reconciliation, and follow up. This includes but is not limited to, providing feedback to leadership, identifying trends and creating spreadsheets.
Functions and Duties
Investigate and identify problem claims to determine root causes of problem and/or errors to address both individual claim resolution and process improvement to avoid issues from occurring in the future.
Contact necessary parties including but not limited to payors and medical providers for additional information or medical verification to verify and report status of claims.
Examine and enter basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines ensuring all mandated government and state regulations are consistently met.
Maintain good working relationships with all internal and external contacts to ensure optimal level of service.
Perform and execute various claims process testing request to ensure desired results are met so support accurate claims payment.
Verify coverage on claims by following normal coverage confirmation procedures, as requested.
Identify trends while answering issues with supporting documentation ie, graphs & spreadsheets to be discussed with department heads.
Ensure accurate entry of work and update information to claim file in regards to claim status, questions or claim payments into any relevant systems including but not limited to Metrix and Meditech.
A minimum of 2 years working experience with insurance precertification and financial clearance.
Schwab Rehabilitation Hospital is a freestanding, not-for-profit, 102-licensed bed facility onChicago’s West and Southwest Side that offers comprehensive inpatient and outpatient programs foradults and children. Schwab is a proud member of Sinai Health System and the first fully licensed andaccredited rehabilitation hospital in the Midwest.Our therapists see patients through the entire continuum o...f care, from acute inpatient admissions atMount Sinai Hospital, to inpatient rehabilitation and outpatient therapy services at Schwab. We alsohave a hospital-based rehabilitation-focused short-term sub-acute unit at Schwab that provides boththerapy and nursing services with exceptional outcomes.Our rehabilitation team takes a holistic, interdisciplinary approach to address the physical, cognitiveand psychosocial needs of each patient. Each patient is assessed and provided with a personalized careplan tailored to help achieve maximal independence and function. Schwab offers seven treatmentgyms featuring private treatment rooms, a warm-water indoor therapy pool, and an award-winningtherapeutic roof top garden.