Business Analyst - Claims

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. The Claims Business Analyst is responsible for researching claims issues, identifying root causes, and creating reports to identify claims denial reasons and trends to recommend resolutions.

Responsibilities:

• Researching claims issues
• Identifying root cause
• Creating reporting to identifying claims denial reasons and trending
• Making recommendations for resolution
• Working with Provider Relations, Systems Configuration, and the Adjustments department to solve claims processing and payment issues
• Taking claims processing issues and identifying the root cause
• Working through any necessary system configuration and/or processing issues with the appropriate departments
• Working with the applicable departments to resolve root cause and ensure impacted claims are processed correctly

Requirements:

• Requires a minimum of 3 - 5 years' experience in medical claims or adjustment processing in a health plan environment
• Bachelor's Degree in Business, HealthCare Management or related field preferred. Additional related work experience may substitute for some educational requirements