Claims Analyst

Job not on LinkedIn

15 hours ago

Apply Now

Receive Emails with Similar Jobs

amps

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Fintech • B2B

AMPS is a leader in healthcare cost reduction for self-funded organizations, dedicated to transforming how businesses manage their healthcare spend. With nearly two decades of expertise, AMPS delivers innovative, member-centric solutions such as PriceDynamix, ClaimInsight, and Drexi that drive savings while maintaining high-quality care. Their personalized approach empowers organizations to take control of their healthcare costs without compromising member well-being, making them a trusted partner in achieving sustainable healthcare savings.

201 - 500 employees

Founded 2005

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

📋 Description

• 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.

🎯 Requirements

• 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. • Bachelor's Degree Preferred • Five or more years of experience in claims analysis or a related field • Certified Professional Coder (CPC) from AAPC and/or Certified Coding Specialist (CCS) certification from AHIMA for medical coding or similar credentials strongly preferred.

🏖️ Benefits

• Indoor office environment with moderate noise • Travel is required for on-site client visits approximately 10% of the time