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AdventHealth Greater Orlando
Altamonte Springs, Florida
WakeMed Health & Hospitals
Raleigh, North Carolina
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JOB SUMMARY The Claims Analyst is accountable for claims processing, research and adjudication to correctly apply benefit determination and pricing for areas of responsibility to include clinic professional claims, hospital and facility inpatient and outpatient claims, and Rx-drug claims (CMS 1500 and UB04), by claims processing guidelines.ESSENTIAL FUNCTIONS OF THE ROLE Processes and adjusts professional and facility claims including, but not limited to, transplant, special handle, negotiations, and MSO according to claims processing guidelines. Maintains confidentiality rules in compliance with HIPPA guidelines.Pends claims as directed by departmental policies and procedures; follows up for resolution and processes pe
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