State Licensed Medical Claims Analyst

Job Summary

A company is looking for a Senior Medical Claims Accuracy Analyst.

Key Responsibilities

• Review complex claims to identify inappropriate coding or billing practices and document findings
• Translate clinical and coding research into actionable logic for developing new claim editing rules
• Monitor regulatory changes and recommend adjustments to claims content based on industry trends

Required Qualifications

• Bachelor's degree in business or healthcare/related field or 10 years in a directly related role
• Active applicable related certificate or license (CCS, CCS-P, CPC, RHIA)
• Minimum of seven years of medical coding expertise, including CPT, ICD-10-PCS, ICD-10-CM, and HCPCS
• Minimum of seven years of experience auditing medical claims for improper payments
• Minimum of seven years of experience performing medical data analysis