VillageCare · 1 day ago
HealthCare Claims Analyst
New York,NY,US
Full-time
Hybrid
Mid, Senior Level
$58K/yr - $65K/yr
3+ years expVillageCare is a community-based, not-for-profit organization serving people with chronic care needs. The HealthCare Claims Analyst position requires expertise in healthcare claims reporting and processing, with a focus on Medicaid and Medicare guidelines, and involves conducting audits and performing root cause analysis.
Health CareHospitalNon Profit
Responsibilities
Understanding healthcare reimbursement from both financial and operational perspectives
Conducting audits and performing root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs)
Identifying gaps in various aspects of claims processing
Communicating trends and contract issues to management
Preparing comprehensive narratives and visual aids for leadership presentations
Coordinating workflows across departments
Ensuring compliance with regulations
Contributing to the development of policies and quality assurance measures
Evaluating claims system coding to validate pricing and improve overall operational efficiency
Qualification
Required
Minimum of five years of experience in healthcare claims reporting and processing
In-depth knowledge of Medicaid and Medicare guidelines
Advanced SQL coding and Excel skills to create insightful reports and dashboards
Bachelor's Degree in a relevant field such as Computer Science, Mathematics, Statistics, or Engineering
Minimum of 3-5 years of experience in business intelligence and analytics
Familiarity with medical terminology and coding systems, including ICD-10, CPT, HCPCS
Knowledge of CMS guidelines and EncoderPro
Excellent technical proficiency in tools such as MS Excel, SQL, Tableau, and Access
Strong communication skills, both written and verbal
Ability to work independently while maintaining a high level of productivity
MUST RESIDE IN NY, NY OR CT
Preferred
Master's degree
Benefits
Medical
Dental
Vision
Life Insurance
Health Savings Account
Competitive Salary
Paid Time Off
Company
VillageCare
VillageCare is a creative and creative ongoing care firm that helps hard to understand the present condition of need for people they serve.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Debra Tirado
Chief Financial Officer
Recent News
Business Journals
2023-04-26
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