Claims Analyst

Job Description:

The Claims Analyst – Professional Billing (PB) is responsible for analyzing, auditing, and resolving claims related to professional (physician and ancillary) services to ensure accurate billing, coding, and reimbursement. This position plays a key role in supporting the revenue cycle by reviewing claim accuracy, identifying trends or discrepancies, and ensuring compliance with payer contracts, coding guidelines, and regulatory standards. The analyst collaborates with providers, coders, billing teams, and payers to optimize claim performance and minimize denials or payment delays.

Key Responsibilities:

Review and analyze professional billing claims for accuracy, completeness, and compliance with payer policies and coding standards (CPT, HCPCS, ICD-10).

Identify, research, and resolve claim rejections, denials, and underpayments through detailed root cause analysis.

Perform claim audits to ensure billing integrity and adherence to pa...