AMPS · 8 hours ago
Claims Analyst
United States
Full-time
Remote
Senior Level
5+ years expAMPS is seeking a Claims Analyst to drive the maturity and success of ClaimInsight. This role involves conducting detailed analytical reviews of inpatient and outpatient claims, ensuring compliance with coding guidelines and improving efficiency and productivity.
Insurance
Responsibilities
Perform retrospective analytical reviews of inpatient and professional claims to evaluate coding accuracy, billing integrity, and reimbursement outcomes
Analyze complex coding scenarios using ICD-10-CM/PCS, CPT, HCPCS, DRG, APC, and payer-specific guidelines
Validate clinical documentation supports assigned codes, modifiers, and levels of service
Identify patterns of coding errors, under-coding, over-coding, or potential compliance risks
Conduct internal audits of medical coding, clinical documentation, and claim submissions to ensure compliance with CMS, OIG, commercial payer, and internal policies
Prepare audit findings, summaries, and recommendations for education or corrective action
Assist in developing and refining audit tools, workflows, and tracking processes
Collaborate with coding teams, clinical staff, and billing departments to clarify documentation and coding issues
Analyze datasets of claim activity to identify trends, anomalies, and areas for improvement
Prepare clear and concise reports for summarizing findings, root-cause analysis, and recommended interventions
Support the development of dashboards or monitoring tools to track coding accuracy and audit outcomes
Stay current with changes in coding guidelines, regulatory updates, and payer billing policies
Ensure claims adhere to federal/state regulations, payer contracts, and organizational standards
Support quality improvement initiatives focused on documentation, coding, and reimbursement accuracy
Partner with coding, revenue cycle, clinical, and recovery teams to resolve coding or billing discrepancies
Provide staff education on audit findings, coding best practices, and documentation requirements
Participate in meetings and workgroups related to coding quality, documentation integrity, and compliance
Qualification
Required
Proven experience in retrospective analytical review of inpatient and professional claims
Deep knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG methodology, APCs, and payer reimbursement rules
Strong analytical, critical thinking, and problem-solving skills
Experience working with EMRs, coding software, and claims/billing platforms
Excellent communication and technical writing skills
Ability to manage multiple priorities with accuracy and attention to detail
Competency in Microsoft applications, including Word, Excel, and Outlook
Five or more years of experience in claims analysis or a related field
Indoor office environment with moderate noise
Travel is required for on-site client visits approximately 10% of the time
Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching, or crawling may be required
Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing
Normal vision abilities required, including close vision and the ability to adjust focus
Preferred
Bachelor's Degree Preferred
Certified Professional Coder (CPC) from AAPC and/or Certified Coding Specialist (CCS) certification from AHIMA for medical coding or similar credentials strongly preferred
Company
AMPS
Advanced Medical Pricing Solutions (AMPS) is a diversified healthcare technology company supporting transparent, affordable medical and prescription benefits through proprietary software as a service (SaaS) products and tech-enabled services offered across the healthcare payer and employer markets.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Matt Brow
Chief Executive Officer and Board Member
Jonathan Jeffress
Chief Operating Officer at Advanced Medical Pricing Solutions (AMPS)
Recent News
Advanced Medical Pricing Solutions (AMPS)
2025-08-21
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2025-06-11
2025-04-23
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