Medical Claims Analyst – Program Integrity & Recovery

Commonwealth of Pennsylvania

Harrisburg (Dauphin County)

Hybrid

USD 42,000 - 56,000

Full time

8 days ago

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Benefits offered by this job

Free parking

Telework option

Job summary

Commonwealth of Pennsylvania is seeking a Medical Assistance Program Technician to support the Bureau of Program Integrity in the Division of Third Party Liability, Recovery. You will review complex medical and financial claims, gather necessary information, and ensure accurate processing of statements of claims in compliance with federal and state rules.

The role emphasizes precise calculation, data interpretation, and adherence to policy.

Qualifications

Three years of para-technical experience in reviewing and responding to inquiries relating to health care insurance programs, health care services, or medical assistance program services.
Any equivalent combination of experience and training.

Responsibilities

Review, analyze, and compute medical, cash, personal injury, and estate claims for recovery.
Decode, analyze, calculate, and summarize information in medical claims.
Contact facilities and agencies to obtain required details.
Calculate and update payment amounts using federal standards.
Review and interpret client encounter data from managed care organizations to explain fiscal processes.
Identify adjustments to claims to create and update statements of claims.
Apply federal and state regulations and policies to follow proper procedures.