HealthCare Claims Analyst

Village Care•New York, NY

2d•Hybrid

About The Position

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. The Full-Time HealthCare Claims Analyst position at VillageCare requires a seasoned professional with a minimum of five years of experience in healthcare claims reporting and processing, alongside in-depth knowledge of Medicaid and Medicare guidelines. The ideal candidate should possess advanced SQL coding and Excel skills to create insightful reports and dashboards. You will play a critical role in understanding healthcare reimbursement from both financial and operational perspectives, conducting audits, and performing root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs). This position involves identifying gaps in various aspects of claims processing, communicating trends and contract issues to management, and preparing comprehensive narratives and visual aids for leadership presentations. You will also coordinate workflows across departments, ensure compliance with regulations, and contribute to the development of policies and quality assurance measures. Your analytical skills will be essential in evaluating claims system coding to validate pricing and improve overall operational efficiency.

Requirements

Minimum of five years of experience in healthcare claims reporting and processing.
In-depth knowledge of Medicaid and Medicare guidelines.
Advanced SQL coding skills.
Advanced Excel skills.
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.
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 reside in NY/NJ/CT.

Nice To Haves

Master's degree preferred.

Responsibilities

Understanding healthcare reimbursement from both financial and operational perspectives.
Conducting audits and 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.