Senior Health Claims Editor and Auditor

Accenture PLC; Austin (TX); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Life insurance

401(k) plan

Bonus opportunities

Paid holidays

Paid time off

Job summary

Accenture is seeking a Health Operations Senior Analyst to support accuracy and effectiveness in healthcare claims editing and auditing. The role analyzes complex claims, edits, and policies to ensure proper coding and dispositions in line with customer requirements.

The position involves researching medical policies, resolving escalated claims, and contributing to work instructions and auditing programs while collaborating with customers and internal teams.

Qualifications

• Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certification in CPC is required or preferred.
• Experience with healthcare claims editing or auditing platforms is a plus.

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 policies to determine impact on edits and audits.
• Evaluate processing issues and identify causes, impacts, and solutions.
• Lead or participate in workgroups focused on processing, editing, auditing, and improvements.
• Support claims processing activities and assist with resolution of complex or escalated claims issues.
• Support customer auditing programs and analyze audit findings.
• Create, review, and maintain claims-processing work instructions and documentation.

Skills

Healthcare claims data

CPC certification

Microsoft Excel

Education

Bachelor’s degree or equivalent

Tools

Excel

Job description

Accenture is seeking a Health Operations Senior Analyst to support accuracy and effectiveness in healthcare claims editing and auditing. The role analyzes complex claims, edits, and policies to ensure proper coding and dispositions in line with customer requirements.

The position involves researching medical policies, resolving escalated claims, and contributing to work instructions and auditing programs while collaborating with customers and internal teams.