Health Admin Services Senior Analyst
About The Position
The Health Operations Senior Analyst supports the accuracy and effectiveness of healthcare claims editing and auditing processes. The role reviews edit and audit groupings to help ensure the appropriate application of codes, criteria, modifiers, and claim dispositions in alignment with customer policies and requirements. The Senior Analyst researches medical policies, investigates complex claims and editing issues, and collaborates with customers and internal teams to identify solutions. The role also supports claims processing, customer auditing programs, and the development and maintenance of work instructions and other operational documentation.
Requirements
- Minimum of 1 year of experience researching or interpreting medical, reimbursement, or claims-processing policies.
- Certified Professional Coder (CPC) certification.
Nice To Haves
- Experience working with healthcare claims data, billing codes, or claims-processing systems.
- Experience using Microsoft Office applications, including Excel.
- Bachelor’s degree or equivalent relevant experience.
- Experience with healthcare claims editing or auditing platforms.
- Understanding of healthcare reimbursement methodologies and claims adjudication processes.
- Experience interpreting medical policies, reimbursement policies, or payer-specific claims requirements.
- Experience analyzing claims-edit logic and determining downstream impacts to claims processing.
- Experience supporting audit programs or responding to audit findings.
- Experience developing or maintaining standard operating procedures, work instructions, or other operational documentation.
- Experience working directly with customers or cross-functional stakeholders.
- Strong analytical and problem-solving skills with demonstrated attention to detail.
- Ability to communicate complex claims or policy issues clearly to technical and non-technical audiences.
- Ability to work independently while effectively managing multiple priorities.
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.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Life coverage
- Long-term disability coverage
- 401(k) plan
- Bonus opportunities
- Paid holidays
- Paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
