Senior Health Claims Editor & Auditor

Accenture PLC; Atlanta (GA); Sur place; USD 34 000 - 87 000; Plein temps

Résumé du poste

Accenture is seeking a Health Operations Senior Analyst to ensure the accuracy and effectiveness of healthcare claims editing and auditing processes. The role analyzes editing groupings, codes, criteria, modifiers, and dispositions in line with customer policies, supporting auditing programs and documentation.

The role conducts policy research, investigates complex claims, and collaborates with customers and internal teams to resolve issues.

Qualifications

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

Responsabilités

• 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.
• Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements.

Connaissances

Healthcare claims analysis

Analytical thinking

Communication skills

Independent work

Formation

Bachelor’s degree or equivalent

CPC certification

Outils

Excel

Microsoft Office

Description du poste

Accenture is seeking a Health Operations Senior Analyst to ensure the accuracy and effectiveness of healthcare claims editing and auditing processes. The role analyzes editing groupings, codes, criteria, modifiers, and dispositions in line with customer policies, supporting auditing programs and documentation.

The role conducts policy research, investigates complex claims, and collaborates with customers and internal teams to resolve issues.