Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for five consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 40 clinic locations, the region’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary

The role of the Insurance Claims & Customer Service Analyst reports to the Billing Manager. This position reviews and processes medical claims for accuracy, ensuring compliance with policies and regulations, and providing customer service to resolve claim-related issues. This position is responsible for verifying coverage, gathering missing information from patients, analyzing claim data, and communicating with healthcare providers, policyholders, and internal teams. This position must have strong analytical, problem-solving and communication skills. The role requires strong analytical, problem-solving and communication skills and must be proficient with medical codes (like ICD-10/CPT).

Essential Position Responsibilities

• Serve as a point of contact for customers, patients, and healthcare providers to answer questions and resolve issues.
• Communicate with stakeholders to gather necessary information and explain claim decisions.
• Provide excellent service to ensure a positive experience for customers.
• Review and audit medical claims for accuracy and completeness.
• Ensure claims comply with policy terms, legal requirements, and company procedures.
• Analyze claim data to identify trends and potential irregularities.
• Apply policy and provider contract provisions to determine if a claim is payable.
• Use computer software and systems to monitor and process claims.
• Obtain missing information from policyholders or involved persons to complete claims.
• Maintain accurate and detailed records of claims processing and outcomes.
• Prepare reports on data such as claims volume and savings.
• Submit and process insurance authorizations efficiently.
• Assist with special projects and help improve departmental policies and procedures.
• Adhere to all HIPAA privacy and 501r regulations

Qualifications

• Education: High school diploma or GED, required. Associates degree in related field preferred.
• Licensure and Certifications: N/A
• Experience: Previous experience in a medical office setting, including knowledge of healthcare insurance protocols, preferred. Proficiency with computer systems, including electronic claims processing systems and Microsoft Office Suite.

Work Environment: This position will spend 20% of time standing and/or walking while pushing, pulling lifting, and/or carrying up to 50 lbs. and 80% of time sitting while performing work in a standard office environment.

Notice: This job description is designed to provide an overview of the essential and principal duties and responsibilities of the position. The job description is not designed or intended to cover or set forth a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Washington Regional reserves the right in its absolute discretion to change duties, responsibilities or activities or assign new duties, responsibilities, or activities at any time with or without notice. Employees may be directed to perform job-related tasks other than those specifically presented in this description.