HealthCare Claims Analyst

Village Care•New York, NY

4d•$65,294 - $72,277•Hybrid

About The Position

Join VillageCare as a Full-Time HealthCare Claims Analyst and take your career to the next level while working from the comfort of your home. With a competitive salary range of $65,294.40 - $72,277, this position offers great financial incentives while allowing you to maintain a flexible work-life balance through hybrid schedule. At VillageCare in New York, NY, you will have the opportunity to contribute to a forward-thinking organization that emphasizes customer-centric solutions and excellence in healthcare. You will be part of an energetic team that values problem-solving and integrity, empowering you to drive meaningful change in the industry. You will be given great benefits such as Medical, Dental, Vision, Life Insurance, Health Savings Account, Competitive Salary, and Paid Time Off. This role not only enhances your professional skills but also places you at the heart of a mission-driven environment focused on making a positive impact in healthcare. Apply today to be part of our dynamic team!

Requirements

Minimum of five years of experience in healthcare claims reporting and processing.
In-depth knowledge of Medicaid and Medicare guidelines.
Advanced SQL coding and Excel skills to create insightful reports and dashboards.
Bachelor's Degree in a relevant field such as Computer Science, Mathematics, Statistics, or Engineering.
Minimum of 3-5 years of experience in business intelligence and analytics, particularly in a healthcare environment where complex data analysis and report/dashboard development are key responsibilities.
Familiarity with medical terminology and coding systems, including ICD-10, CPT, HCPCS.
Knowledge of CMS guidelines and EncoderPro.
Excellent technical proficiency in tools such as MS Excel, SQL, Tableau, and Access.
Strong communication skills, both written and verbal.
Ability to work independently while maintaining a high level of productivity.
Must be able to work independently with high level of productivity and advanced written and verbal communication skills.
Excellent technical skills (MS Excel, SQL, Tableau, Access, etc.)
Strong communication skills.

Nice To Haves

Master's degree preferred.

Responsibilities

Understanding healthcare reimbursement from both financial and operational perspectives.
Conducting audits.
Performing root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs).
Identifying gaps in various aspects of claims processing.
Communicating trends and contract issues to management.
Preparing comprehensive narratives and visual aids for leadership presentations.
Coordinating workflows across departments.
Ensuring compliance with regulations.
Contributing to the development of policies and quality assurance measures.
Evaluating claims system coding to validate pricing and improve overall operational efficiency.