Professional Billing Claims Analyst

Job Summary

Providing end-to-end support for Professional Billing (PB) claims processing, the remote contract Professional Billing Claims Analyst will review, validate, and adjudicate claims while investigating complex issues and collaborating with internal teams to ensure compliance and improve processes.

Key responsibilities

• Review, validate, and adjudicate professional/physician billing claims for accuracy and compliance
• Investigate and resolve complex claim issues, denials, and escalations related to PB claims
• Analyze claim rejections and denial trends, recommending corrective actions to enhance first-pass yield

Required qualifications

• Strong experience in Professional Billing (PB) claims processing (physician/hospital outpatient billing)
• Hands-on experience with claim adjudication, denial management, and AR follow-ups
• Deep understanding of CPT, ICD-10, modifiers, and payer-specific billing guidelines
• Experience working in a senior/lead PB claims analyst role
• Ability to independently handle complex claims and escalations