Hybrid Claims Audit & Payment Integrity Analyst

Community Care Plan; Town of Florida (NY); Híbrido; USD 28 000 - 34 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Hybrid work schedule

Resumo da oferta

Community Care Plan is seeking a Claims Analyst to support accurate and timely claims payment through audits, analysis, and payment integrity activities. The role reviews professional and facility claims, identifies discrepancies, and collaborates with internal teams to resolve issues and improve processing.

You will analyze overpayments, coding issues, and reimbursement policies while contributing to system testing and training.

Qualificações

• High school diploma or GED required; five to seven years of related claims experience and/or training.
• Medical coding certification such as CPC preferred.
• Familiarity with ICD-10-CM, HCPCS Level II and III, CPT, revenue codes, and DRG coding on UB-04 and CMS-1500 claim types.

Responsabilidades

• Perform daily claims audits and review professional and facility claims to identify payment errors and discrepancies.
• Validate claims against member benefits, provider contracts, fee schedules, and reimbursement policies.
• Analyze overpayments, underpayments, and coding issues to identify root causes and recommend corrective action.
• Process claims adjustments, reprocessing, and refunds as needed.
• Support first-level appeals and resolve complex claims-related questions.

Conhecimentos

Claims analysis

Communication

Problem solving

Formação académica

High school diploma or GED

Associate degree preferred

Ferramentas

CPC/Coding knowledge

Descrição da oferta de emprego

Community Care Plan is seeking a Claims Analyst to support accurate and timely claims payment through audits, analysis, and payment integrity activities. The role reviews professional and facility claims, identifies discrepancies, and collaborates with internal teams to resolve issues and improve processing.

You will analyze overpayments, coding issues, and reimbursement policies while contributing to system testing and training.