Health Admin Services Senior Analyst

Accenture PLC; Miami (FL); Vor Ort; USD 30.000 - 63.000; Vollzeit

Zusammenfassung

Accenture is seeking a Health Operations Senior Analyst to review edits/audits, research medical policies, and support claims processing. You will collaborate with customers and internal teams to resolve complex issues and contribute to the development of standard work instructions and documentation.

The role emphasizes analytical problem-solving, attention to detail, and ability to handle multiple priorities in a healthcare claims environment.

Qualifikationen

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

Aufgaben

• Analyze complex healthcare claims, editing, and auditing issues and recommend resolutions.
• Review claims edits and audit groupings for accuracy, including codes, criteria, modifiers, and dispositions.
• Research medical policies to determine impact on edits and audits.
• Evaluate processing issues and identify causes, impacts, and solutions.
• Collaborate with customers and teams to resolve questions and support business needs.
• Lead or participate in workgroups on claims processing, editing, auditing, and improvements.
• Support processing activities and assist with complex claims.
• Support customer auditing programs including analysis of findings.
• Create and maintain claims-processing work instructions and documentation.
• Identify opportunities to improve accuracy and efficiency of edits and audits.
• Communicate findings and recommendations clearly to stakeholders.

Kenntnisse

CPC certification

Healthcare claims data experience

Analytical skills

Communication skills

Independent work

Ausbildung

Bachelor’s degree or equivalent

Tools

Excel

Claims editing platforms

CRM systems

Jobbeschreibung

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 (CPC) certification

Preferred Qualifications

• Experience working with healthcare claims data, billing codes, or claims-processing systems.

• Experience using Microsoft Office applications, including Excel.

• Bachelor’s degree or equivalent relevant experience.

• Experience with healthcare claims editing or auditing platforms.

• Understanding of healthcare reimbursement methodologies and claims adjudication processes.

• Experience interpreting medical policies, reimbursement policies, or payer-specific claims requirements.

• Experience analyzing claims-edit logic and determining downstream impacts to claims processing.

• Experience supporting audit programs or responding to audit findings.

• Experience developing or maintaining standard operating procedures, work instructions, or other operational documentation.

• Experience working directly with customers or cross-functional stakeholders.

• Strong analytical and problem-solving skills with demonstrated attention to detail.

• Ability to communicate complex claims or policy issues clearly to technical and non-technical audiences.

• Ability to work independently while effectively managing multiple priorities.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below.

We anticipate this job posting will be posted until 11/28/2026. Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. See more information on our benefits here: U.S. Employee Benefits | Accenture (https://www.accenture.com/us-en/careers/local/benefits)

Role Location Hourly Salary Range

California $26.39 to $63.13

Colorado $26.39 to $54.52

Connecticut $26.39 to $54.52

District of Columbia $28.08 to $58.08

Illinois $24.42 to $54.52

Maine $22.45 to $46.44

Maryland $26.39 to $54.52

Massachusetts $26.39 to $58.08

Minnesota $26.39 to $54.52

New York $24.42 to $63.13

New Jersey $28.08 to $63.13

Ohio $24.42 to $50.48

Virginia $24.42 to $58.08

Washington $28.08 to $58.08

Requesting an Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences.All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.

For details, view a copy of theAccenture Equal Opportunity Statement (https://www.accenture.com/content/dam/accenture/final/accenture-com/document-4/Accenture-Equal-Opportunity-Statement.pdf#zoom=50)

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Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

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