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Claims Review Analyst

Fa Evzu Saasfaprod1 Fa Ocs Oraclecloud Com CX 1 · United States; 7399 Westbranch Hwy-Lewisburg-EMP, Lewisburg, PA, US; 601 Memory Ln-Admin Bld Memory Ln 601A-EMP, York, PA, US · Active · Oracle Recruiting Cloud / Fusion HCM

Job facts

FieldValue
CompanyFa Evzu Saasfaprod1 Fa Ocs Oraclecloud Com CX 1
TitleClaims Review Analyst
Normalized title-
Department / teamRevenue Cycle
LocationUnited States
Work model-
Employment typeFull Time
Salary-
Statusactive
ATS providerOracle Recruiting Cloud / Fusion HCM
Posted / first seen2026-04-29 / 2026-05-31
Changed / last seen2026-06-06 / 2026-06-06

Related slices

PageWhat it containsOpen
Company jobsActive postings from Fa Evzu Saasfaprod1 Fa Ocs Oraclecloud Com CX 1.Open
Company breakdownsRole, location, ATS, and work model facets for this company.Open
ATS provider jobsActive postings observed through Oracle Recruiting Cloud / Fusion HCM.Open
Provider filtered searchThe same provider as a filtered job collection.Open
Department jobsActive postings in Revenue Cycle.Open
Lifecycle eventsOpen, update, close, and reopen events for this posting.Open
Original postingCanonical source or apply URL captured from the ATS.Open

Linked records

CompanyFa Evzu Saasfaprod1 Fa Ocs Oraclecloud Com CX 1
Source141e2fa9-69c2-4818-bbbf-c9689ea3d0fe
ATS providerOracle Recruiting Cloud / Fusion HCM

Description

Description General Summary Supports the system in charge capture, coding accuracy, and claim denials management. Conducts reviews of claim denials and submits appeals. Performs a variety of functions including, but not limited to answering inquiries and researching third party payer policies and coding guidelines to optimize reimbursement for the system while ensuring compliance with applicable laws and regulations. Responsibilities Duties and Responsibilities Essential Functions: Consults with departments throughout the system on charge processes. Ensures appropriate use of CPT, HCPCS and ICD-10 codes as well as modifiers. Conducts reviews comparing medical record documentation to validate charge capture, medical necessity, and coding accuracy. Investigates and recommends action steps and works collaboratively with the department when coding and/or compliance issues are found. Identifies denial trends, billing errors, and determines root cause to prevent future denials. Investigates billing system errors, through help desk tickets and work queues, due to potentially inappropriate documentation, coding, medical necessity or charge entry. Communicates with departments, including Compliance to initiate steps for resolution. Investigates payer denials and institutes appropriate courses of action. Prepares detailed appeals and attends Medicare Administrative Law Judge (ALJ) hearings as necessary for Medicare Interacts with providers, managers, and staff in departments to ensure correct coding of claims. Maintains current knowledge of payer/insurance policies, rules and regulations, including state and federal guidelines. Demonstrates initiative and resourcefulness by communicating results of claims review activity to PCS and PFS Leadership. Serves as point person for department when assigned and consistently displays good judgment, decision making and independence in the role, with minimal guidance and supervision. Attends insurance update meetings, provides synopsis of bulletins and notifies affected areas. Requests coding edits in EPIC based on payer bulletins and/or policies. Assists leadership in PCS and PFS in the completion of routine assignments and special projects as needed. Approves and processes all PB fee schedule requests via Remedy Force. Creates and presents yearly ICD-10 and CPT changes. Presents education, training and feedback to providers, practice managers and staff. Common Expectations: Adheres to established policies and procedures, objectives and quality assessment and safety standards. Enhances professional growth and development through participation in educational programs, current literature, in-services meetings and workshops. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. Qualifications Qualifications Minimum Education: High School Diploma or GED Required Associates Degree Preferred Work Experience: 3 years Billing/Claims and Coding experience. Required Licenses: Certified Professional Coder Upon Hire Required or Certified Coding Specialist - Physician Based Upon Hire Required or Certified Medical Coder Upon Hire Required or Registered Health Information Technician Upon Hire Required Knowledge, Skills, and Abilities: Excellent communication and interpersonal skills. Excellent oral presentation skills. Experience with public speaking and basic computer skills. Works effectively in a team environment. Benefits Offered: Comprehensive health benefits Retirement savings plan Paid time off (PTO) Education assistance Financial education and support, including DailyPay Expanded Paid Parental Leave For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

Full job record

Job ID59b3ce40f6d911df96e99bb4d7b4fb936709ed86
Org IDb484349d-18e7-4347-bf77-a24fb2cebde7
Source ID141e2fa9-69c2-4818-bbbf-c9689ea3d0fe
Board ID141e2fa9-69c2-4818-bbbf-c9689ea3d0fe
Provideroracle_hcm
Provider Job Key223928
TitleClaims Review Analyst
Normalized Title
Statusactive
Activeyes
Location TextUnited States; 7399 Westbranch Hwy-Lewisburg-EMP, Lewisburg, PA, US; 601 Memory Ln-Admin Bld Memory Ln 601A-EMP, York, PA, US
DepartmentRevenue Cycle
Team
Employment Typefull_time
Workplace Type
Remote Policy
CountryUnited States
Region
City
Salary RawDescription General Summary Supports the system in charge capture, coding accuracy, and claim denials management. Conducts reviews of claim denials and submits appeals. Performs a variety of functions including, but not limited to answering inquiries and researching third party payer policies and coding guidelines to optimize reimbursement for the system while ensuring compliance with applicable laws and regulations. Responsibilities Duties and Responsibilities Essential Functions: Consults with departments throughout the system on charge processes. Ensures appropriate use of CPT, HCPCS and ICD-10 codes as well as modifiers. Conducts reviews comparing medical record documentation to validate charge capture, medical necessity, and coding accuracy. Investigates and recommends action steps and works collaboratively with the department when coding and/or compliance issues are found. Identifies denial trends, billing errors, and determines root cause to prevent future denials. Investigates billing system errors, through help desk tickets and work queues, due to potentially inappropriate documentation, coding, medical necessity or charge entry. Communicates with departments, including Compliance to initiate steps for resolution. Investigates payer denials and institutes appropriate courses of action. Prepares detailed appeals and attends Medicare Administrative Law Judge (ALJ) hearings as necessary for Medicare Interacts with providers, managers, and staff in departments to ensure correct coding of claims. Maintains current knowledge of payer/insurance policies, rules and regulations, including state and federal guidelines. Demonstrates initiative and resourcefulness by communicating results of claims review activity to PCS and PFS Leadership. Serves as point person for department when assigned and consistently displays good judgment, decision making and independence in the role, with minimal guidance and supervision. Attends insurance update meetings, provides synopsis of bulletins and notifies affected areas. Requests coding edits in EPIC based on payer bulletins and/or policies. Assists leadership in PCS and PFS in the completion of routine assignments and special projects as needed. Approves and processes all PB fee schedule requests via Remedy Force. Creates and presents yearly ICD-10 and CPT changes. Presents education, training and feedback to providers, practice managers and staff. Common Expectations: Adheres to established policies and procedures, objectives and quality assessment and safety standards. Enhances professional growth and development through participation in educational programs, current literature, in-services meetings and workshops. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. Qualifications Qualifications Minimum Education: High School Diploma or GED Required Associates Degree Preferred Work Experience: 3 years Billing/Claims and Coding experience. Required Licenses: Certified Professional Coder Upon Hire Required or Certified Coding Specialist - Physician Based Upon Hire Required or Certified Medical Coder Upon Hire Required or Registered Health Information Technician Upon Hire Required Knowledge, Skills, and Abilities: Excellent communication and interpersonal skills. Excellent oral presentation skills. Experience with public speaking and basic computer skills. Works effectively in a team environment. Benefits Offered: Comprehensive health benefits Retirement savings plan Paid time off (PTO) Education assistance Financial education and support, including DailyPay Expanded Paid Parental Leave For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)
Salary Min
Salary Max
Salary Currency
Salary Period
Source URLhttps://fa-evzu-saasfaprod1.fa.ocs.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/223928
Apply URLhttps://fa-evzu-saasfaprod1.fa.ocs.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/223928
First Seen At2026-05-31 17:57:11Z
Last Seen At2026-06-06 19:24:29Z
Last Checked At2026-06-06 19:24:29Z
Last Changed At2026-06-06 19:24:29Z
Inactive At
Source Posted At2026-04-29 16:43:13Z
Source Updated At
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=oracle_hcm/board=fa-evzu-saasfaprod1.fa.ocs.oraclecloud.com|CX_1/date=2026-06-06/2026-06-06T19-23-34-216Z-2f20e85ccb3e29486896386b360c095d2e329e80823af4601dc3a5489ee71292.json
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