Health Care Claims Analyst
New
C
Campus OpportunitiesHealthcare Consulting
Remote, Eastern Time Zone preferredFull-TimeEntry
Salary not disclosed
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Job Details
- Experience
- 1 year
- Required Skills
- SQLData AnalysisMicrosoft Office
Requirements
- Bachelor’s degree in Healthcare Administration, Business, Accounting, Analytics, Public Health, or a related field (preferred).
- 1 year of experience in healthcare consulting, provider billing, insurance claims adjudication, or related area.
- Knowledge of medical claims processing practices including interpretation of plan benefits.
- Knowledge of medical coding terminology (e.g., Revenue, DRG, CPT, ICD-10, NDC codes).
- Proficiency in Microsoft Office and data analysis tools.
- Relevant experience working for a medical TPA (adjudicating or auditing) may be considered in lieu of a degree.
- Ability to work effectively in a remote environment with minimal travel.
- Familiarity with healthcare databases and systems (preferred).
- Experience with Alteryx, SQL, and other data analysis tools (preferred).
- Experience with risk-based consulting methodologies (preferred).
Responsibilities
- Perform audits and quality assurance processes related to claims processing.
- Prepare working papers, which record and summarize data in accordance with professional standards.
- Organize and maintain audit support files, workpapers, and other relevant documentation.
- Analyze healthcare claims data to identify patterns and anomalies.
- Prepare detailed reports and dashboards for internal and client use.
- Collaborate with cross-functional teams to implement data-driven solutions.
- Ensure compliance with healthcare regulations and data privacy standards.
- Work as an active team member during scheduled engagements.
- Provide feedback to the team lead on any issues identified during research or claims review.
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