Join our dynamic Operations team at a rapidly growing healthcare organization. As a Medical/Pharmacy Claims Analyst, you will play a pivotal role in ensuring the accuracy and efficiency of medical claims processing through our advanced clearinghouse system.
Key Responsibilities
Review and reconcile medical claims daily to verify successful transmission to payers via our clearinghouse.
Assess claims for payment accuracy according to processing guidelines.
Investigate and resolve issues related to denied or inaccurately paid claims, collaborating closely with Pharmacy Support and Client Services.
Monitor claim activities closely, promptly identifying and communicating any potential issues to maintain seamless operations.
Demonstrate flexibility by taking on additional tasks as needed to support operational needs.
Uphold strict confidentiality and security standards in compliance with HIPAA regulations.
Qualifications
Minimum 2 years of experience in healthcare claims and transactions.
Familiarity with medical and/or pharmacy billing and coding preferred.
Knowledge of X12 and NCPDP transaction formats is advantageous.
SQL proficiency is a plus but not required.
Strong communication, problem-solving, and attention to detail to manage high claim volumes efficiently.
Benefits & Perks
Comprehensive healthcare coverage, including medical, dental, vision.
Generous paid holidays and unlimited paid time off.
401(k) savings plan with company match.
Flexible remote and in-office work options.
About Us
Join a collaborative team dedicated to accuracy and reliability in healthcare claim processing. We value your expertise and offer an environment where your contributions make a meaningful impact on our mission to prioritize patient care.
Employment Type: Full-Time
Seniority level
Entry level
Employment type
Full-time
Job function
Finance and Sales
Industries
Human Resources Services
Referrals increase your chances of interviewing at Get It Recruit - Healthcare by 2x