Senior Health Claims Auditor & Policy Analyst

Accenture PLC; Detroit (MI); On-site; USD 34,000 - 75,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Life insurance

Long-term disability

401(k)

Bonus opportunities

Paid holidays

Paid time off

Job summary

Accenture plc Health Operations is seeking a Senior Analyst to enhance claims editing and auditing processes, reviewing edits, codes, and dispositions to ensure policy alignment. The role researches medical policies, investigates complex claims, and collaborates with customers and internal teams to identify solutions.

The position supports claims processing, customer auditing programs, and the development and maintenance of standard operating procedures and work instructions, while managing

Qualifications

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

Responsibilities

• 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.

Skills

Analytical skills

Communication

Independent work

Problem solving

Education

Bachelor’s degree or equivalent relevant experience

Tools

Excel

Microsoft Office

Job description

Accenture plc Health Operations is seeking a Senior Analyst to enhance claims editing and auditing processes, reviewing edits, codes, and dispositions to ensure policy alignment. The role researches medical policies, investigates complex claims, and collaborates with customers and internal teams to identify solutions.

The position supports claims processing, customer auditing programs, and the development and maintenance of standard operating procedures and work instructions, while managing