Healthcare Claims Quality Analyst

Accenture PLC; St. Louis (MO); On-site; USD 33,000 - 76,000; Full time

Job summary

Accenture PLC seeks a Health Operations Senior Analyst to ensure accurate claims editing and auditing against customer policies. You will research medical policies, investigate complex claims, and collaborate with customers and internal teams to implement effective solutions.

You will analyze edits, review groupings for accuracy, and contribute to workgroups aimed at improving processing and documentation. Strong analytical skills and attention to detail are essential.

Qualifications

• Minimum of 1 year researching or interpreting medical, reimbursement, or claims-processing policies.
• CPC certification is required.
• Bachelor’s degree or equivalent experience is preferred.
• Experience with healthcare claims data, billing codes, or claims-processing systems is beneficial.
• Proficiency with Microsoft Excel and other Office tools.

Responsibilities

• 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 claims edits and audits.
• Collaborate with customers and cross-functional teams 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 complex or escalated claims issues.
• Develop or maintain claims-processing work instructions and related documentation.
• Identify opportunities to improve accuracy, consistency, and efficiency of edits and audits.

Skills

Analytical skills

Attention to detail

Communication to technical audiences

Education

Bachelor’s degree or equivalent

CPC certification

Tools

Microsoft Excel

Microsoft Office

Healthcare claims editing platforms

Job description

Accenture PLC seeks a Health Operations Senior Analyst to ensure accurate claims editing and auditing against customer policies. You will research medical policies, investigate complex claims, and collaborate with customers and internal teams to implement effective solutions.

You will analyze edits, review groupings for accuracy, and contribute to workgroups aimed at improving processing and documentation. Strong analytical skills and attention to detail are essential.