Medical/Pharmacy Claims Analyst - Remote

Join our Operations team as a Medical/Pharmacy Claims Analyst at a rapidly growing healthcare startup. In this role, you'll play a crucial part in ensuring the accuracy and efficiency of medical claims processed through our clearinghouse. We're seeking a detail-oriented professional with a background in healthcare claims transactions and a commitment to excellence.

At our company, we value collaboration and precision, striving to uphold our mission of delivering seamless patient care through reliable processes.

Responsibilities

As a Medical/Pharmacy Claims Analyst, your responsibilities will include:

Daily review and reconciliation of medical claims processed via the clearinghouse to confirm payer receipt

Assessment of claim accuracy according to processing guidelines

Investigation and resolution of denied or incorrectly paid claims, collaborating with Pharmacy Support and Client Services as needed

Prompt identification and communication of operational issues to ensure uninterrupted claims processing

Flexibility to undertake additional tasks as required to support team goals

Upholding strict confidentiality and security standards for healthcare data under HIPAA guidelines

Qualifications

2+ years of experience in healthcare claims management

Familiarity with medical and/or pharmacy billing and coding practices preferred

Experience with X12 and NCPDP transaction formats is advantageous

Knowledge of SQL is a plus, though not required

Strong communication skills, adept problem-solving abilities, and keen attention to detail to manage high claim volumes efficiently

Benefits & Perks

Comprehensive healthcare coverage, including medical, dental, vision

Generous paid holidays and unlimited paid time off

401(k) savings plan with company matching

Hybrid remote and in-office work options

Employment Type: Full-Time