Medical Records Analyst I
Job Locations: US
Category (Portal Searching)
Health Care Services
Medical Records Analyst I
Bring your experience to a role where you will:
- Perform triage on all claims selected to determine if a claim will be reviewed according to specific clinical review and audit criteria.
- Prepare and sends specific record request letters to providers that identify the records required or obtains records via EMR systems.
- Receive, research and process incoming records received via fax, mail, e-mail, and secure upload.
- Input claim processing instructions or information into Facets and communicates with designated claims staff regarding the status of claims selected for review.
- Complete and monitors required fields and notes in the department database.
- Send detailed notification letters to providers and communicates directly with Network Management regarding missing or needed records.
Responsibilities & Requirements
Competencies and Knowledge:
- Effective communication and writing skills.
- Experience with health care systems and documentation (medical records, billing and claims); familiarity with Facets system preferred.
- Ability to investigate and research issues related to clinical programs and medical records and to take initiative to solve problems.
- Ability to work independently, to prioritize work, meet deadlines, and achieve operational standards.
- Proficiency with medical terminology. Knowledge of medical anatomy and coding preferred.
- Math aptitude and analytical ability.
- Knowledge of Blue Card, ITS processes, FEP Direct and Salesforce preferred.
Normally to be proficient in the competencies listed above:
- Medical Records Analyst I would have a high school diploma or GED, and 3 years experience in healthcare field (medical office, customer service, billing) or related formal education and at least 1 year experience or equivalent combination of education and experience.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We’ve been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.