Health Admin Services Senior Analyst

1036 Accenture State Hc. Company; Austin (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

1036 Accenture State Hc. Company Health Operations Senior Analyst role focuses on accuracy of healthcare claims editing and auditing, researching policies, and supporting customer programs in alignment with requirements.

You will analyze complex claims, collaborate with customers and teams, and help develop work instructions and documentation to improve processing and outcomes.

Qualifications

• Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certified Professional Coder (CPC) certification may be preferred.

Responsibilities

• Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions.
• Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions.
• Research medical, reimbursement, and customer policies to determine their impact on claims edits and audits.
• Evaluate claims processing issues and identify potential causes, impacts, and solutions.
• Work collaboratively with customers, operational teams, and other stakeholders to resolve questions and support business needs.
• Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements.
• Support claims processing activities and assist with the resolution of complex or escalated claims issues.
• Support customer auditing programs, including research and analysis of audit findings.
• Assist with the creation, review, and ongoing maintenance of claims-processing work instructions, procedures, and supporting documentation.
• Identify opportunities to improve the accuracy, consistency, and efficiency of claims editing and auditing processes.
• Communicate findings and recommendations clearly to both internal stakeholders and customers.
• Manage multiple priorities while maintaining accuracy and attention to detail.

Job description

The Health Operations Senior Analyst supports the accuracy and effectiveness of healthcare claims editing and auditing processes. This role reviews edit and audit groupings to help ensure the appropriate application of codes, criteria, modifiers, and claim dispositions in alignment with customer policies and requirements. The Senior Analyst researches medical policies, investigates complex claims and editing issues, and collaborates with customers and internal teams to identify solutions. The role also supports claims processing, customer auditing programs, and the development and maintenance of work instructions and other operational documentation.

In this role, you will:

• Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions.
• Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions.
• Research medical, reimbursement, and customer policies to determine their impact on claims edits and audits.
• Evaluate claims processing issues and identify potential causes, impacts, and solutions.
• Work collaboratively with customers, operational teams, and other stakeholders to resolve questions and support business needs.
• Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements.
• Support claims processing activities and assist with the resolution of complex or escalated claims issues.
• Support customer auditing programs, including research and analysis of audit findings.
• Assist with the creation, review, and ongoing maintenance of claims-processing work instructions, procedures, and supporting documentation.
• Identify opportunities to improve the accuracy, consistency, and efficiency of claims editing and auditing processes.
• Communicate findings and recommendations clearly to both internal stakeholders and customers.
• Manage multiple priorities while maintaining accuracy and attention to detail.

Basic Qualifications

• Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certified Professional Coder (