We are seeking a Claims & Billing Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations
About the Role:
The Claims & Billing Analyst plays a critical role in ensuring the accuracy and efficiency of healthcare billing and claims processing within the organization. This position is responsible for analyzing, reviewing, and resolving complex billing issues to optimize revenue cycle management. The analyst collaborates closely with healthcare providers, insurance companies, and internal departments to verify claims, identify discrepancies, and facilitate timely reimbursements. By maintaining compliance with healthcare regulations and payer policies, the role helps minimize denials and delays in payment. Ultimately, the Claims & Billing Analyst contributes to the financial health of the organization by ensuring that claims are processed accurately and efficiently.
Minimum Qualifications:
- Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field.
- Minimum of 2 years of experience in medical billing, claims processing, or revenue cycle management.
- Strong knowledge of healthcare billing codes, insurance claim procedures, and payer guidelines.
- Proficiency with billing software and electronic health record (EHR) systems.
- Excellent analytical, problem-solving, and communication skills.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
Preferred Qualifications:
- Master's degree in Healthcare Administration, Business, Finance, or a related field.
- Certification such as Certified Professional Biller (CPB) or Certified Coding Specialist (CCS).
- Experience working with Medicare, Medicaid, and private insurance claims.
- Familiarity with healthcare compliance standards such as HIPAA and the Affordable Care Act.
- Advanced skills in data analysis and reporting tools.
- Prior experience in a healthcare provider or insurance company environment.
Responsibilities:
- Review and analyze healthcare claims for accuracy, completeness, and compliance with payer requirements.
- Investigate and resolve billing discrepancies and denials by coordinating with providers, payers, and internal teams.
- Prepare and submit claims to insurance companies and follow up on unpaid or rejected claims to ensure timely reimbursement.
- Maintain detailed records of claims processing activities and generate reports to track performance metrics and identify trends.
- Stay current with changes in healthcare billing regulations, payer policies, and industry best practices to ensure compliance.
Skills Required
- Bachelor's degree in Healthcare Administration, Business, Finance, or a related field
- Minimum of 2 years of experience in medical billing, claims processing, or revenue cycle management
- Strong knowledge of healthcare billing codes, insurance claim procedures, and payer guidelines
- Proficiency with billing software and electronic health record (EHR) systems
- Excellent analytical, problem-solving, and communication skills
- Relevant experience may substitute for the educational requirement on a year-for-year basis
- Master's degree in Healthcare Administration, Business, Finance, or a related field
- Certification such as Certified Professional Biller (CPB) or Certified Coding Specialist (CCS)
- Experience working with Medicare, Medicaid, and private insurance claims
- Familiarity with healthcare compliance standards such as HIPAA and the Affordable Care Act
- Advanced skills in data analysis and reporting tools
- Prior experience in a healthcare provider or insurance company environment
What We Do
Independent Living Systems, LLC, offers a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid and Dual-Eligible Market. Independent Living Systems has been an industry leader in managing home and community-based programs for over 16 years. Leveraging ILS’ award winning technology platform, ILS provides assistance beyond the clinical realm at every stage of care from hospitalization to the treatment of chronic illnesses to personalized care management including nutritional support. As one of the country’s leading providers of Nutritional Support Services and medically tailored meals, ILS provides nutrition counseling and home delivered meals for individuals transitioning from acute settings to the home as well as for those combatting the effects of one or more chronic diseases. In partnership with health plans, providers, hospitals, and pharmaceutical and medical device companies, ILS provides solutions aimed at improving health outcomes while rebalancing costs. ILS’ suite of products and services include: MLTSS - Managed Long-Term Services Supports Suite of solutions including assessments, care management, and coordination of home and community-based services, care planning, and back-office support CCM - Comprehensive Care Management A streamlined solution for ongoing care management and care optimization targeted towards special needs populations and special needs plans Meals and Nutrition One of the nation’s largest nutritional providers delivering consistent, high-quality therapeutic meals to elderly and at-risk populations TPA – Third Party Administration A fully integrated business and technology offering to support all administrative and financial reporting requirements of health plans and risk bearing entities MSO – Management Services Organization Population and provider-based interventions to address utilization and monitor unit costs of services For more information please contact us via email at [email protected].
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