Senior Health Claims Editor & Auditor

Accenture PLC; Kirkland (WA); On-site; USD 48,000 - 80,000; Full time

Job summary

Accenture is seeking a Health Operations Senior Analyst in the United States for Kirkland, WA to support the accuracy of healthcare claims editing and auditing processes. You will analyze complex claims, review edits, and research policies to determine impacts on edits and dispositions.

You will collaborate with customers and internal teams to resolve questions and drive improvements. The role requires CPC certification, 1+ year of policy research experience, and strong Excel skills.

Qualifications

• Minimum 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
• Certified Professional Coder (CPC) certification.
• Experience with healthcare claims data, billing codes, or claims-processing systems.
• Experience using Microsoft Excel.

Responsibilities

• Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions.
• Review claims edits and audit groupings for accuracy, including codes, criteria, modifiers, and dispositions.
• Research medical, reimbursement, and customer policies and determine their impact on edits and audits.
• Evaluate processing issues and identify causes, impacts, and solutions.
• Collaborate with customers and internal teams to resolve questions and support business needs.
• Lead or participate in workgroups focused on claims processing and operational improvements.
• Support processing activities and assist with resolution of complex or escalated claims issues.
• Assist with creation and maintenance of claims-processing work instructions and documentation.
• Identify opportunities to improve accuracy, consistency, and efficiency of edits and audits.

Skills

Analytical thinking

Attention to detail

Effective communication

Independent work

Education

Bachelor’s degree or equivalent relevant experience

CPC certification

Tools

Microsoft Excel

Job description

Accenture is seeking a Health Operations Senior Analyst in the United States for Kirkland, WA to support the accuracy of healthcare claims editing and auditing processes. You will analyze complex claims, review edits, and research policies to determine impacts on edits and dispositions.

You will collaborate with customers and internal teams to resolve questions and drive improvements. The role requires CPC certification, 1+ year of policy research experience, and strong Excel skills.