Join our dynamic Operations team at a leading healthcare organization dedicated to ensuring seamless medical claims processing. We are committed to accuracy and reliability in support of our mission to prioritize patient care above all else.
Position Overview
As a Medical/Pharmacy Claims Analyst, you will play a key role in our Operations team, responsible for monitoring and analyzing medical claims processed through our clearinghouse. Your expertise in healthcare claims transactions and billing will ensure the accuracy and efficiency of our claims processing operations.
Responsibilities
Review and reconcile daily medical claims submissions via our clearinghouse to verify successful payer receipt.
Evaluate claims for payment accuracy according to processing guidelines.
Investigate and resolve discrepancies in denied or inaccurately paid claims.
Collaborate closely with Pharmacy Support and Client Services to address claim-related inquiries and ensure accurate processing.
Promptly identify and communicate operational issues to maintain uninterrupted claims processing.
Willingness to assist with additional tasks as required to support team objectives.
Maintain strict confidentiality and adhere to HIPAA regulations regarding healthcare data security.
Qualifications
Minimum 2 years of experience in healthcare claims and related transactions.
Familiarity with medical and/or pharmacy billing and coding practices preferred.
Knowledge of X12 and NCPDP transaction formats is advantageous.
SQL knowledge is a plus but not required.
Strong communication, problem-solving, and attention to detail to manage high claim volumes and resolve issues efficiently.
Benefits & Perks
Comprehensive healthcare coverage, including medical, dental, vision.
Paid holidays and unlimited paid time off.
401(k) savings plan with company match.
Flexible remote and in-office work options.
Employment Type: Full-Time
Seniority level
Entry level
Employment type
Full-time
Job function
Finance and Sales
Industries
Human Resources Services
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