Medicare Claims Analyst

Job Summary

Working remotely in a full-time capacity, the Medicare Claims Analyst II will be responsible for the organization and review of Medicare and Medicaid claims, including re-pricing and calculating overpayments, while supporting fraud investigations and program integrity initiatives.

Key responsibilities:

• Maintain workflow balance to ensure timely completion of re-pricing requests
• Utilize medical terminology and coding principles to accurately re-price claims
• Prepare monthly prepay saving reports and facilitate the movement of claims for review

Required qualifications:

• Extensive knowledge of medical terminology and coding principles
• Knowledge of Medicare guidelines and experience with Medicare/Medicaid claims
• One year or more experience in medical terminology and Medicare claims payment systems or CPC certification
• A high school diploma; a two-year degree with a healthcare emphasis is preferred
• Must have no adverse actions pending by any State or Federal licensing board