Claims Analyst

Remote/Full-time

Join Our Mission at Genesis Orthopedics & Sports Medicine!

At Genesis Orthopedics & Sports Medicine, we believe high-quality orthopedic care should be accessible to all—not just those who can afford it. After 17 years of conventional practice, we took a step back, challenged the status quo, and reimagined healthcare delivery. Over four years, through hundreds of hours of research, global case studies, and bold innovation, we developed a new model that maintains our reputation for exceptional care while making our services more ethical and affordable.

Key Responsibilities 

• Operations & Oversight
• 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.
  
• Team Management
• 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.
  
• Claims & Denial Management
• 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.
  
• Analytics & Reporting
• 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.
  
• Compliance & Continuous 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.