Global Claims Management Analyst

🔥 12 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $26 - $33 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

👻 Ghost score 0%

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Baptist Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Baptist Health is the region's largest not-for-profit healthcare organization in South Florida. It operates 12 hospitals, more than 29,000 employees, 4,500 physicians, and roughly 200 outpatient centers, urgent care facilities, and physician practices across Miami-Dade, Monroe, Broward, and Palm Beach counties. The system includes renowned centers of excellence in cancer, heart and vascular, brain and spine, and orthopedic care, and is supported by philanthropy and a faith-based mission. Baptist Health emphasizes clinical quality, patient safety, staff development, and community-oriented care.

📋 Description

• Execute all Claims Management and Third Party Administrative (TPA) functions for system-wide Domestic and International lines of business • Accurately audit and analyze medical claims • Manage timely payer collections and claim adjudication • Maintain, develop and administer the PNS Contract Management Process • Back up Team Lead(s) for Para-Claim Parathon solution management • Analyze claim data to identify anomalies, trends and discrepancies • Manage the physician claims appeal and reimbursement reconsideration process for all lines of business • Support Team Lead(s) and leadership in departmental process improvement initiatives • Support department leaders and Team Lead during payment and reconciliation processes as needed

🎯 Requirements

• Associate degree • 5 years of experience • Strong background in Medical Insurance Billing and collections, coding, claims regulations, revenue cycle, provider contract management, operational support and registration • Solid understanding of hospital operations, contractual analysis, FDA health regulations, HIPPA regulations, DRG guidelines • Exceptional administrative skills • Thorough understanding of all required fields on a 1500 and/or UB for hospitals, diagnostic facilities and physician practices • Excellent written and verbal communication skills • Superb customer service skills • Ability to work independently, demonstrate a high level of initiative, prioritize deadlines and make decisions • Results driven, with a desire to work in a fast-paced environment that values collaboration, integrity and customer focus • Experience preferred with JDA ACO, Web Tool Parathon, EPSi, Soarian Financials, Cerner Power Chart, Business Objectives Enterprise, MS Power BI, Pro Diver or other payer modeling

🏖️ Benefits

• Career growth and development opportunities, with clear pathways and ongoing support • Comprehensive health and wellness resources that go beyond traditional benefits • A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs • Tuition reimbursement to support continued learning and advancement