Senior Healthcare Claims Analyst & Coding Expert

TURNINGPOINT HEALTHCARE SOLUTIONS LLC; United States; On-site; USD 60,000 - 85,000; Full time

Job summary

TurningPoint Healthcare Solutions LLC is seeking a Claims Analyst to analyze claims data, ensure coding and charge accuracy, and manage records for clinical review. The role requires evaluating policy coverage and maintaining HIPAA compliance.

Candidates should have 5+ years in claim processing and 2+ years in healthcare operations, with strong Excel and communication skills. The position focuses on accurate adjudication support, responses to provider inquiries, and adherence to service level

Qualifications

• 2+ years experience in Customer Service or healthcare operations.
• 5+ years claim processing experience.
• High School Diploma required; Associates/Bachelors in Healthcare preferred.

Responsibilities

• Analyze surgical claims data from physicians and facilities for coding and charge accuracy.
• Request medical records to support additional research and review of the claim.
• Process and prepare medical records for clinical review by a nurse or physician.
• Review implant configurations for coding and unit accuracy.
• Manage all reviews and medical record requests within SLAs.
• Identify and aggregate provider information for consistently inaccurate or fraudulent claims.

Skills

HIPAA compliance

Claim analysis

Communication skills

Microsoft Excel

Multitasking

Problem solving

Education

High School Diploma or equivalent

Associate’s or Bachelor’s in Healthcare

Tools

Microsoft Office

Job description

TurningPoint Healthcare Solutions LLC is seeking a Claims Analyst to analyze claims data, ensure coding and charge accuracy, and manage records for clinical review. The role requires evaluating policy coverage and maintaining HIPAA compliance.

Candidates should have 5+ years in claim processing and 2+ years in healthcare operations, with strong Excel and communication skills. The position focuses on accurate adjudication support, responses to provider inquiries, and adherence to service level