Medical/Pharmacy Claims Analyst
4 weeks ago
Overview
As part of the Operations team at Free Market Health, the Medical/Pharmacy Claims Analyst will be primarily responsible for monitoring the day-to-day activity regarding medical claims processed through our medical claims clearinghouse. In addition, this role will assist in analysis of paid medical and pharmacy claims to ensure accuracy. The ideal candidate has an understanding of healthcare claims transactions and medical billing.
As part of a growing team in a fast-paced, start-up environment, we are looking for a Medical/Pharmacy Claims Analyst that will bring their expertise to a team that values collaboration and a passion for accuracy and reliability in support of our mission to never let the process fail the patient.
Specifics
The specific responsibilities for this role include, but are not limited to:
- Reviewing and reconciling medical claims submitted through the medical claims clearinghouse daily to ensure successful receipt by the payers
- Reviewing claims for payment accuracy based on processing rules
- Identifying and following up on denied claims or claims that are paid inaccurately and assisting in resolution
- Working closely with Pharmacy Support and Client Services to answer claim related questions and proactively alert when actions are needed for accurate claim processing
- Identifying and quickly communicating any issues to ensure seamless operation of daily claims activity
- Willingness to take on additional tasks as needed
- A commitment to protecting the confidentiality and security of sensitive healthcare information in accordance with HIPAA.
Qualifications
- 2+ years of experience with healthcare claims and related transactions
- Knowledge of medical and/or pharmacy billing and/or coding is preferred
- Experience working with X12 and NCPDP transaction formats is preferred
- SQL knowledge is preferred but not required
- Strong communication, problem-solving, and detail-oriented skills to be able to efficiently monitor significant claim volume while multi-tasking to follow up on ongoing problem resolution.
Benefits & Perks:
- Comprehensive healthcare coverage, including medical, dental, vision
- Paid holidays and unlimited paid time off
- 401(k) savings plan with company match
- Remote and in-office flexibility
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