Certified Medical Claims Analyst

Job Summary

A company is looking for a Medical Claims Accuracy Analyst.

Key Responsibilities

• Review professional and facility claims for inappropriate coding or billing practices and document findings
• Identify and research medical claims coding issues and analyze claims data to inform rule development
• Collaborate across departments and provide formal responses to provider inquiries regarding claim edits

Required Qualifications

• 5+ years of Medical Coding Expertise including CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC
• 5+ years' experience auditing medical claims as a Payment Integrity Vendor or within a Health Plan's Payment Integrity team
• 5+ years of experience performing data analysis
• Minimum associate's degree in business or healthcare-related field or 8 years of directly related experience
• Active applicable related certificate or license (CCS, CCS-P, CPC, RHIA, etc)