These professionals must have knowledge of standard claims coding and the ability to process all claim types, as well as experience with healthcare benefits structures and insurance procedures. Candidates should have strong writing and verbal skills and be proficient with Microsoft Office and familiar with HIPAA provisions. An associate’s degree or commensurate work experience is required.
Typical claims examiner analyst duties:
Reviewing and evaluating incoming claims for appropriate coding against the charges that are being billedDetermining the level of reimbursement based on established criteria, provider contract or plan provisionsDenying all claims ineligible for payment and entering coding informationIdentifying and reporting inaccuracies that are related to system configuration, benefit inconsistency and fee schedulesIdentifying circumstances that require claim payment, development or denial and producing the appropriate corresponding outcomes
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Salary for Claims Examiner Analyst Healthcare in Philadelphia, PA
54755 -
78638
25th percentile
54755
The candidate is new to the role and building the needed skills, experience and autonomy.
50th percentile
67279
The candidate has the experience to perform core responsibilities without direct supervision and is comfortable with the role’s processes and subject matter.
75th percentile
78638
The candidate delivers value beyond the stated job duties, has advanced qualifications and experience, and is ready for the next career level.
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