Healthcare Reimbursement Analyst

Job Summary

Analyzing healthcare claims for overpayment opportunities, the full-time remote Healthcare Reimbursement Analyst will utilize various tools and regulations to identify errors, collaborate with cross-functional teams, and maintain accurate audit documentation.

Key responsibilities

• Analyze healthcare claims to identify overpayments and recovery opportunities based on reimbursement policies and regulations
• Review paid claims and member eligibility data to detect trends and potential audit opportunities
• Collaborate with internal teams to validate and recover overpaid claims while recommending enhancements to audit processes

Required qualifications

• High school diploma or GED required; bachelor's degree preferred
• 4-6 years of healthcare reimbursement experience in areas such as claims analysis and auditing
• Demonstrated knowledge of healthcare claims processing, including ICD-9-CM and CPT codes
• Experience in healthcare auditing and validating claims data accuracy preferred
• Familiarity with CMS regulations and published healthcare guidelines