Healthcare Reimbursement Analyst

Job Summary

To support healthcare payment accuracy initiatives, the full-time remote Healthcare Reimbursement Analyst will analyze healthcare claims to identify overpayments and collaborate with various teams to recover funds while maintaining accurate documentation.

Key responsibilities

• Analyze healthcare claims using reimbursement policies and regulations to identify overpayment opportunities
• Review paid claims and member eligibility data to uncover overpayment trends and potential audit opportunities
• Collaborate with internal teams to validate and recover overpaid claims while recommending process enhancements

Required qualifications

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