Claims Analyst

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October 10

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Genesis Orthopedics & Sports Medicine

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Healthcare Insurance • Pharmaceuticals • Wellness

Genesis Orthopedics & Sports Medicine is an orthopedic care provider that offers a comprehensive range of services, including orthopedic surgery, physical therapy, and urgent care for sports injuries. With multiple locations throughout Chicago, Genesis prides itself on providing accessible and high-quality care, having treated over 40,000 patients and receiving over 90% five-star reviews. They utilize advanced medical technologies such as MRI scans and Platelet-Rich Plasma (PRP) injections, and they also offer virtual physical therapy services to ensure that patients receive the best possible health outcomes.

51 - 200 employees

Founded 2000

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧘 Wellness

📋 Description

• Review and validate all contractual adjustments and ensure accuracy in claim posting and payer compliance. • Download and allocate new accounts to analysts from multiple EPIC workqueues based on payer, aging, and priority. • Audit processed claims for accuracy, completeness, and timeliness before submission or follow-up. • Perform quality checks and ensure analysts follow correct claim handling procedures. • Conduct daily and weekly performance reviews, tracking productivity and accuracy metrics. • Lead and support a team of claims analysts, providing guidance, performance feedback, and escalation support. • Review and summarize EOD (End of Day) and EOW (End of Week) reports to evaluate team output and resolve discrepancies. • Manage task assignments, track turnaround times, and balance workloads across analysts. • Provide training and corrective coaching when errors or trends are identified. • Oversee denial trending and root cause analysis for all orthopedic-related claims. • Identify and escalate systemic issues such as incorrect coding, missing documentation, or payer configuration errors. • Work closely with billing, coding, and authorization teams to resolve high-value or high-impact claims. • Ensure claims are submitted, followed up, and appealed in accordance with payer guidelines and timely filing limits. • Prepare and distribute daily, weekly, and monthly reports on claim status, denial trends, and AR performance. • Monitor KPIs such as denial rate, claim turnaround time, and first-pass resolution rate. • Track performance metrics for the entire team and provide data-driven recommendations for improvement. • Ensure all claim activities comply with HIPAA, payer rules, and internal SOPs. • Stay current with orthopedic coding changes, payer updates, and EPIC workflows. • Recommend and implement process improvements to enhance claim accuracy and reduce rework. • Participate in audits and provide supporting claim documentation when required.

🎯 Requirements

• 3–5 years of experience in medical claims management or billing, with a strong focus on orthopedic claims. • Proven experience managing or leading a claims or AR team in a healthcare setting. • Hands-on experience with EPIC system is required. • Excellent understanding of CPT/HCPCS codes, modifiers, EOBs, ERAs, CARC/RARC codes, and payer-specific denial handling. • Advanced Excel skills (pivot tables, lookups, trend tracking). • Exceptional attention to detail and strong problem-solving abilities. • Excellent communication skills and ability to work cross-functionally with billing, coding, and management teams.

🏖️ Benefits

• Supportive Team – Be part of a compassionate and professional healthcare team that values collaboration. • Competitive Compensation – Enjoy a strong base salary with opportunities for performance-based bonuses. • Meaningful Impact – Help us revolutionize healthcare by making top-tier orthopedic care accessible to everyone.