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Claim Configuration Analyst Jobs in Alabama (NOW HIRING)

IPG Photonics

Systems Administrator

Huntsville, AL · On-site

The ideal candidate is a flexible, driven, diligent worker that can analyze the environment both as ... Actively claim, triage, and resolve IT tickets and contribute to the teams overall SLA matrixes.

IPG Photonics

Systems Administrator

Huntsville, AL · On-site

$80 - $100/hr

The ideal candidate is a flexible, driven, diligent worker that can analyze the environment both as ... Create and maintain system configuration, and troubleshooting documentation as needed. * Review all ...

All JobsClaim Configuration Analyst JobsClaim Configuration Analyst Jobs in Alabama

Claim Configuration Analyst information

What is a claim configuration analyst?

Claim Configuration Analysts are professionals who specialize in setting up and maintaining the rules, processes, and systems that handle insurance claims within an organization. They ensure that claim processing systems are configured accurately to follow policy guidelines, regulatory requirements, and company procedures. Their role often involves analyzing data, troubleshooting issues, and collaborating with IT, claims, and business teams to optimize claim workflows. By ensuring correct system configurations, they help reduce errors, improve operational efficiency, and support timely claim resolutions.

What are the key skills and qualifications needed to thrive as a claim configuration analyst, and why are they important?

To thrive as a Claim Configuration Analyst, you need a strong understanding of healthcare claims processing, benefits administration, and analytical problem-solving, often supported by a degree in business, information systems, or a related field. Familiarity with claims adjudication systems (such as Facets or QNXT), SQL, and potentially industry certifications like Certified Claims Professional (CCP) are commonly required. Attention to detail, effective communication, and the ability to work collaboratively with cross-functional teams are crucial soft skills. These competencies ensure accurate claim system configuration, regulatory compliance, and efficient operations within health insurance organizations.

What are some common challenges faced by claim configuration analysts, and how can they be addressed?

Claim Configuration Analysts often encounter challenges such as interpreting complex insurance policies, ensuring accurate system configuration to minimize claim errors, and keeping up with frequent regulatory changes. Addressing these challenges requires strong analytical skills, attention to detail, and effective collaboration with cross-functional teams like IT, compliance, and claims processing. Regular training and open communication channels help analysts stay updated and maintain high-quality configurations, ultimately reducing errors and improving efficiency.

What is the difference between Claim Configuration Analyst vs Claims Processor?

AspectClaim Configuration AnalystClaims Processor
Primary ResponsibilitiesDesigns and manages claim system setups, analyzes configuration issues, and optimizes claim workflows.Processes individual claims, verifies information, and ensures accurate claim adjudication.
Required Skills & CertificationsKnowledge of insurance systems, data analysis, and possibly certifications like CPCU or similar.Attention to detail, familiarity with claims software, and basic insurance knowledge.
Work EnvironmentTypically office-based, working with IT teams and claims systems.Office or remote, handling claims directly or via claims processing platforms.

The Claim Configuration Analyst focuses on configuring and optimizing claim systems and workflows, while the Claims Processor handles the day-to-day processing of individual claims. Both roles require insurance knowledge, but the analyst role emphasizes system setup and analysis, whereas the processor role emphasizes claim review and verification.

Is claims processing a stressful job?

Claims processing as a Claim Configuration Analyst can be stressful due to tight deadlines, high accuracy requirements, and the need to resolve complex issues efficiently. The role often involves detailed data analysis and communication with stakeholders, which can contribute to work-related stress. However, workload and stress levels vary depending on the organization and individual workload management skills.

What are popular job titles related to Claim Configuration Analyst jobs in Alabama?

For Claim Configuration Analyst jobs in Alabama, the most frequently searched job titles are:

What job categories do people searching Claim Configuration Analyst jobs in Alabama look for?

The top searched job categories for Claim Configuration Analyst jobs in Alabama are:

What cities in Alabama are hiring for Claim Configuration Analyst jobs?

Cities in Alabama with the most Claim Configuration Analyst job openings:

Claim Configuration Analyst jobs near you

Contract Management Reimbursement Analyst -USA Health Shared Services, Business Office Administra...

USA Health Systems

Mobile, AL • On-site

Full-time

Posted 24 days ago

Job description

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

Responsibilities
  • Loads executed managed care contracts into the contract management system
  • Updates contracts with scheduled rate changes as of effective dates
  • Builds new service definitions and implements new reimbursement methodology into the system as required
  • Consults with contract negotiators to recommend precise language and meaning of contracts
  • Ensures that the contract template accurately calculates the terms of the contract as negotiated
  • Monitors periodic changes in recognized coding schemes (ICD, CPT, and DRG) to anticipate impacts on contract language, calculations and reimbursement of specific contracts using those codes
  • Reviews cases and writes appeals
  • Assists in coordinating and maintaining the reimbursement program for USA Health System to ensure compliance with current payments, rules and legislative regulations that impact billing and collections processes
  • Monitors and ensures compliance with Medicare and Medicaid documentation guidelines for USA Health
  • Monitors and evaluates current reimbursements/payment rules and ensures legislative and regulatory changes impacting USA Health
  • Communicates to staff and departmental billing personnel any changes impacting billing
  • Develops techniques for effective analyses of billing collection efforts
  • Ensures compliance with Medicare and insurance carrier guidelines related to documentation, coding and medical necessity
  • Analyzes and develops systems related to billing, collecting and reporting of professional and medical services to ensure recovery of all professional and technical charges
  • Trains new personnel in appropriate charge capture and provides on-going in-service training for billing personnel
  • Provides reimbursement patterns and trend analyses to managers and Directors
  • Assists in resolving third party denials received by Billing and Collections department and assists with reimbursement appeals and problems
  • Prepares reports and analyses to include financial reports, setting forth progress, adverse trends and appropriate recommendations or conclusion
  • Participates in meetings with subordinates to ensure compliance with established practices to new policies and to keep employees aware of changes and current standards
  • Works claim edits and work queues within practice management system.
  • Identifies and resolves claim issues related to coding, documentation, payer requirements, and system configuration.
  • Completes all mandatory department, educational and hospital requirements
  • Adheres to current Infection Control and Safety Standards
  • Regular and prompt attendance
  • Ability to work schedule as defined and overtime as required
  • Related duties as assigned
Additional Information

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

Qualifications
  • Bachelor's Degree from an accredited institution and 1 year of medical coding or related experience Required
  • Directly related experience may substitute on a year-for-year basis for the required education Required
  • Certification as a Certified Professional Coder within 1 Year Required
  • Comparable combination of education and experience may substitute for the above requirements.
Employment Type: FULL_TIME

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