Senior Healthcare Claims & Edits Analyst

Accenture PLC; Houston (TX); On-site; USD 39,000 - 83,000; Full time

Job summary

Accenture Health Operations is seeking a Health Operations Senior Analyst in the United States to support accuracy in claims editing and auditing. You will review edits, research policies, and collaborate with customers to drive solutions, improvements, and documentation.

The role requires CPC certification and experience with healthcare claims data, along with strong analytical skills and the ability to manage multiple priorities across stakeholders.

Qualifications

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

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, reimbursement, and customer policies to determine their impact on claims edits and audits.
• Evaluate claims processing issues and identify potential causes, impacts, and solutions.
• Work collaboratively with customers, operational teams, and other stakeholders to resolve questions and support business needs.
• Lead or participate in workgroups focused on claims processing, editing, auditing, and operational improvements.
• Support claims processing activities and assist with the resolution of complex or escalated claims issues.
• Support customer auditing programs, including research and analysis of audit findings.
• Assist with the creation, review, and ongoing maintenance of claims-processing work instructions, procedures, and supporting documentation.
• Identify opportunities to improve the accuracy, consistency, and efficiency of claims editing and auditing processes.
• Communicate findings and recommendations clearly to both internal stakeholders and customers.
• Manage multiple priorities while maintaining accuracy and attention to detail.

Skills

Claims analysis

Editing & auditing

CPC certification

Education

Bachelor’s degree or equivalent

Tools

Microsoft Excel

Claims processing platforms

Job description

Accenture Health Operations is seeking a Health Operations Senior Analyst in the United States to support accuracy in claims editing and auditing. You will review edits, research policies, and collaborate with customers to drive solutions, improvements, and documentation.

The role requires CPC certification and experience with healthcare claims data, along with strong analytical skills and the ability to manage multiple priorities across stakeholders.