Healthcare Claims Analyst

VanderHouwen; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare company is looking for a Claims Analyst to support their team in a remote capacity. The role involves researching and resolving pharmacy claims, serving as a subject matter expert on reimbursement processes, and preparing analytical reports. Candidates should have a Bachelor's degree, 1-3 years of healthcare billing experience, and be familiar with Medicare and coding certifications. This is a great opportunity for a detail-oriented individual ready to work cross-functionally.

Qualifications

• Bachelor's degree in Business, Healthcare, or related field; equivalent experience considered.
• 1-3 years of experience in healthcare billing, revenue cycle, coding, or pharmacy claims.
• Strong knowledge of Medicare, third-party billing codes, CPT/HCPCS, ICD-10, and NCCI/MUE edits.
• Certified Pharmacy Technician or coding certifications (CPC, RHIT) preferred.
• Advanced analytical and interpersonal skills with the ability to work cross-functionally.

Responsibilities

• Research, resolve, and follow up on rejected or unpaid pharmacy claims for accurate reimbursement.
• Serve as a subject matter expert on reimbursement, provider relationships, and claims processes.
• Prepare reports, analyze trends, and communicate findings effectively to stakeholders.

Job description

A company is looking for a Claims Analyst (Healthcare) to support their team in a remote capacity.

Key Responsibilities

• Research, resolve, and follow up on rejected or unpaid pharmacy claims for accurate reimbursement
• Serve as a subject matter expert on reimbursement, provider relationships, and claims processes
• Prepare reports, analyze trends, and communicate findings effectively to stakeholders

Required Qualifications

• Bachelor's degree in Business, Healthcare, or related field; equivalent experience considered
• 1-3 years of experience in healthcare billing, revenue cycle, coding, or pharmacy claims
• Strong knowledge of Medicare, third-party billing codes, CPT/HCPCS, ICD-10, and NCCI/MUE edits
• Certified Pharmacy Technician or coding certifications (CPC, RHIT) preferred
• Advanced analytical and interpersonal skills with the ability to work cross-functionally