Continuous Monitoring Analyst at Leidos, an industry leader in digital and mission innovations. Adapting strategies to outpace competitors while ensuring mission success.
About the role
- Claims Analyst reviewing and analyzing medical records and claims for accuracy and compliance with regulations. Collaborating with healthcare providers and supporting audits within defined timelines.
Responsibilities
- Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
- Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
- Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
- Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
- Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
- Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
- Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
- Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
- Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.
Requirements
- Any Graduate/Postgraduate
- 1-3 years of Experience
- Good communication, flexibility, reliability
- Knowledge in Microsoft Outlook/Excel/Word/PPT
- Strong Analytical skills with the ability to investigate and resolve issues
- Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.
Benefits
- Complete the necessary training and meet the expectations outlined for the position.
- Follow all standard operating procedures (SOP) diligently.
- Complete audits promptly and ensure high quality.
- Strive to meet both quality and production targets.
- Adhere to project protocols and instructions.
- Report any issues or trends promptly.
- Maintain the logs (such as productivity, clarification, and others as applicable) updated.
- Seek clarification from the manager or team leader when needed.
- Promptly respond to all emails from the manager.
- Ensure compliance with all relevant regulations and policies.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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