Claims Analyst

Claims Analyst Mary Bird Perkins Cancer Center is Louisiana’s leading cancer care organization, caring for more patients each year than any other facility in the region. With strategic hospital and physician partnerships, we are delivering on our mission to improve survivorship and lessen the burden of cancer. Job Description SCOPE The Claims Analyst is responsible for the advanced review, analysis, and resolution of complex insurance claims, with a primary focus on denials and appeals. This role handles high-dollar and escalated claims, supports denial prevention efforts, and serves as a resource to other team members. Analyst III applies in-depth knowledge of payer requirements, billing guidelines, and reimbursement processes to maximize revenue recovery and improve overall claims performance. FUNCTIONS Advanced Claims Review & Resolution: Analyze and resolve complex, denied, or underpaid claims across multiple payers. Independently manage high-dollar and aged accounts requiring detailed research and ensure timely resolution in accordance with payer deadlines. Appeals Management: Prepare and submit first- and second-level appeals. Compile and review supporting documentation including medical records and coding validation. Monitor appeal status through final resolution. Scheduling & Appointment Coordination: Identify root causes of denials and recurring issues. Communicate trends to leadership and recommend corrective actions to reduce future denials. Payer Interaction: Interpret payer policies, EOBs, and reimbursement guidelines. Participate in payer communications to resolve complex claim issues. Documentation & Compliance: Maintain accurate documentation of claim activity. Ensure compliance with payer requirements, regulatory guidelines, and internal policies. Support audits and documentation reviews. Reporting & Performance Support: Assist in tracking denial trends, appeal outcomes, and recovery efforts. Contribute to productivity goals and recommend workflow improvements. QUALIFICATIONS Associate degree or certification in Medical Billing preferred (or equivalent experience) 23+ years in medical billing, claims processing, or accounts receivable Experience handling complex denials and appeals Familiarity with Medicare, Medicaid, and commercial payers Specialized Knowledge Proficiency in Microsoft Office including word processing, spreadsheets, database, presentation software, and Crystal Report Writer. Must type a minimum of 65 wpm. Strong knowledge of CPT, ICD-10, and HCPCS coding. Advanced understanding of EOBs and denial codes. Proficiency in EHR/PM systems. #J-18808-Ljbffr