Join our Operations team as a Medical/Pharmacy Claims Analyst at a rapidly growing healthcare startup. In this role, you'll play a crucial part in ensuring the accuracy and efficiency of medical claims processed through our clearinghouse. We're seeking a detail-oriented professional with a background in healthcare claims transactions and a commitment to excellence.
At our company, we value collaboration and precision, striving to uphold our mission of delivering seamless patient care through reliable processes.
Responsibilities
As a Medical/Pharmacy Claims Analyst, your responsibilities will include:
Daily review and reconciliation of medical claims processed via the clearinghouse to confirm payer receipt
Assessment of claim accuracy according to processing guidelines
Investigation and resolution of denied or incorrectly paid claims, collaborating with Pharmacy Support and Client Services as needed
Prompt identification and communication of operational issues to ensure uninterrupted claims processing
Flexibility to undertake additional tasks as required to support team goals
Upholding strict confidentiality and security standards for healthcare data under HIPAA guidelines
Qualifications
2+ years of experience in healthcare claims management
Familiarity with medical and/or pharmacy billing and coding practices preferred
Experience with X12 and NCPDP transaction formats is advantageous
Knowledge of SQL is a plus, though not required
Strong communication skills, adept problem-solving abilities, and keen 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 matching
Hybrid remote and in-office work options
Employment Type: Full-Time
Seniority level
Entry level
Employment type
Full-time
Job function
Finance and Sales
Industries
Human Resources Services
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