Claims Analyst Manager

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.