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VillageCare · 1 day ago

HealthCare Claims Analyst

New York,NY,US

Full-time

Hybrid

Mid, Senior Level

$58K/yr - $65K/yr

5+ years exp

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs. The Full-Time HealthCare Claims Analyst position involves analyzing healthcare claims, conducting audits, and ensuring compliance while being part of a mission-driven environment focused on making a positive impact in healthcare.

Health CareHospitalNon Profit

Responsibilities

Understand healthcare reimbursement from both financial and operational perspectives

Conduct audits and perform root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs)

Identify gaps in various aspects of claims processing

Communicate trends and contract issues to management

Prepare comprehensive narratives and visual aids for leadership presentations

Coordinate workflows across departments

Ensure compliance with regulations

Contribute to the development of policies and quality assurance measures

Evaluate claims system coding to validate pricing and improve overall operational efficiency

Qualification

SQLExcelBusiness IntelligenceHealthcare Claims ProcessingTableauAccessICD-10CPTHCPCSAnalytical SkillsCommunication SkillsProblem-Solving

Required

Bachelor's Degree required ideally in a relevant field such as Computer Science, Mathematics, Statistics, and/or Engineering

Minimum of 3-5 years' experience in business intelligence and analytics performing increasingly complex data analysis and report/dashboard development preferably in a healthcare setting

Knowledge of medical terminology, ICD-10, CPT, HCPCS coding CMS guidelines and EncoderPro are required

Must be able to work independently with high level of productivity and advanced written and verbal communication skills

Excellent technical skills (MS Excel, SQL, Tableau, Access, etc.)

Strong communication skills

MUST RESIDE IN NY, NY OR CT