Join our dynamic Operations team as a Medical/Pharmacy Claims Analyst! In this role, you'll play a key part in monitoring daily activities related to medical claims processed through our medical claims clearinghouse. You'll also assist in analyzing paid medical and pharmacy claims to ensure accuracy. We seek a candidate with a solid understanding of healthcare claims transactions and medical billing.
As part of a growing team in a fast-paced, start-up environment, you'll bring your expertise to a team that values collaboration, accuracy, and reliability. Your efforts will support our mission to ensure the process never fails the patient.
Key Responsibilities
Daily Claims Review: Monitor and reconcile medical claims submitted through the medical claims clearinghouse to ensure successful receipt by payers.
Accuracy Checks: Review claims for payment accuracy based on processing rules.
Issue Resolution: Identify and follow up on denied claims or claims paid inaccurately, assisting in their resolution.
Collaboration: Work closely with Pharmacy Support and Client Services to answer claim-related questions and proactively alert when actions are needed for accurate claim processing.
Communication: Identify and quickly communicate any issues to ensure the seamless operation of daily claims activity.
Adaptability: Take on additional tasks as needed.
Confidentiality: Commit to protecting the confidentiality and security of sensitive healthcare information in accordance with HIPAA.
Qualifications
2+ years of experience with healthcare claims and related transactions.
Preferred Knowledge Of Medical And/or Pharmacy Billing And/or Coding.
Preferred experience working with X12 and NCPDP transaction formats.
SQL knowledge is a plus but not required.
Strong communication, problem-solving, and detail-oriented skills to efficiently monitor significant claim volume while multitasking to follow up on ongoing problem resolution.
Benefits & Perks
Comprehensive healthcare coverage, including medical, dental, and vision.
Paid holidays and unlimited paid time off.
401(k) savings plan with company match.
Remote and in-office flexibility.
Join our team and make a meaningful impact in the healthcare industry!
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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