Reimbursement Analyst II

Job Summary

Working remotely, the full-time Reimbursement Analyst II will manage full claim overpayment analysis, assist in identifying claims paid in error, and audit paid claims data using various tools and regulations.

Key responsibilities

• Utilizes CMS, state, and client billing policies to identify claim overpayments with limited oversight
• Participates in reviewing paid health insurance claims and member eligibility to uncover overpayment trends
• Collaborates with data miners and stakeholders to track and document overpaid claims and communicate results

Required qualifications

• 4-6 years of healthcare reimbursement experience, including claims analysis and auditing
• Demonstrated knowledge of healthcare claims processing for Medicaid, Medicare, and commercial insurance
• Experience applying healthcare guidelines such as CMS regulations to claims data
• Excellent analytical and time management skills
• Knowledge of Medicaid, Medicare, and commercial policy and reimbursement preferred