Senior Health Claims Editor & Auditor

Accenture PLC; Seattle (WA); On-site; USD 39,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Life insurance

Long-term disability

401(k) plan

Bonus opportunities

Paid holidays

Paid time off

Job summary

Accenture PLC in the United States is seeking a Health Operations Senior Analyst to ensure accurate claims editing and auditing in line with customer policies. You will research policies, investigate complex claims, and collaborate with customers and internal teams to implement solutions.

Ideal candidates have CPC certification, experience with claims processing systems, and strong analytical skills. The role involves multiple priorities, documentation updates, and contributing to process

Qualifications

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

Responsibilities

• Analyze complex healthcare claims editing and auditing issues and recommend resolutions.
• Review claims edits and audit groupings for accuracy, including codes, criteria, modifiers, and dispositions.
• Research medical, reimbursement, and customer policies to determine impact on edits and audits.
• Evaluate processing issues and identify potential causes, impacts, and solutions.
• Collaborate with customers and teams to resolve questions and support business needs.
• Lead or participate in workgroups on processing, editing, auditing, and improvements.
• Support claims processing activities and resolve complex or escalated claims issues.
• Support customer auditing programs and analyze audit findings.
• Create and maintain claims-processing work instructions and procedures.

Skills

CPC certification

Healthcare claims data

Analytical thinking

Communication skills

Education

Bachelor's degree or equivalent relevant experience

Tools

Microsoft Excel

Claims processing systems

Job description

Accenture PLC in the United States is seeking a Health Operations Senior Analyst to ensure accurate claims editing and auditing in line with customer policies. You will research policies, investigate complex claims, and collaborate with customers and internal teams to implement solutions.

Ideal candidates have CPC certification, experience with claims processing systems, and strong analytical skills. The role involves multiple priorities, documentation updates, and contributing to process