Global Claims Management Analyst

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee all Claims Management and Third Party Administrative (TPA) operations for both Domestic and International lines of business.

• Conduct thorough audits and analysis of medical claims.

• Ensure timely collections from payers and effective claim adjudication.

• Develop, maintain, and manage the PNS Contract Management Process.

• Serve as a backup for Team Lead(s) in managing the Para-Claim Parathon solution.

• Examine claim data to uncover anomalies, trends, and discrepancies.

• Oversee the physician claims appeal and reimbursement reconsideration process across all lines of business.

• Assist Team Lead(s) and leadership with departmental process enhancement initiatives.

• Provide support to department leaders and Team Lead during payment and reconciliation activities as necessary.

⛳️ Requirements

• Associate degree is required.

• Minimum of 5 years of relevant experience.

• Strong expertise in Medical Insurance Billing and collections, coding, claims regulations, revenue cycle, provider contract management, operational support, and registration.

• Comprehensive knowledge of hospital operations, contractual analysis, FDA health regulations, HIPAA regulations, and DRG guidelines.

• Outstanding administrative skills are essential.

• In-depth understanding of all required fields on a 1500 and/or UB form for hospitals, diagnostic facilities, and physician practices.

• Excellent verbal and written communication skills.

• Exceptional customer service abilities.

• Capability to work autonomously, showing a high level of initiative, meeting deadlines, and making informed decisions.

• Results-oriented mindset, with a desire to thrive in a fast-paced environment that prioritizes collaboration, integrity, and customer focus.

• Preferred experience with JDA ACO, Web Tool Parathon, EPSi, Soarian Financials, Cerner Power Chart, Business Objectives Enterprise, MS Power BI, Pro Diver, or other payer modeling tools.

🏝️ Benefits

• Opportunities for career growth and development, with clear pathways and continuous support.

• Comprehensive health and wellness resources that extend beyond traditional benefits.

• A wellness program designed to help employees eliminate their medical plan deductible, thereby reducing out-of-pocket healthcare expenses.

• Tuition reimbursement to facilitate ongoing learning and professional advancement.