Reimbursement Analyst

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Evaluate healthcare claims in accordance with CMS, state, client, and payer reimbursement policies, regulations, and billing guidelines to discover overpayments and recovery opportunities.

• Analyze paid claims and member eligibility information to detect overpayment trends, patterns, and potential audit opportunities.

• Work in conjunction with data analysts, clinical teams, IT resources, and business stakeholders to identify, validate, and retrieve overpaid claims.

• Maintain audit documentation, track findings, and communicate outcomes to both internal and external stakeholders.

• Meet individual and team performance objectives while contributing to departmental goals.

• Suggest and implement improvements to audit processes, methodologies, and data queries.

• Investigate provider billing practices, claims processing trends, and reimbursement policies to identify recovery opportunities.

• Assist in the development and evaluation of audit concepts and payment integrity initiatives.

• Prepare supporting documentation, sample claims, and audit approval materials for client assessment and implementation.

• Investigate and apply industry standards, clinical guidelines, and regulatory requirements.

• Monitor recovery efforts until resolution is achieved.

• Generate reports, metrics, and tracking tools.

⛳️ Requirements

• A high school diploma or GED is required; a bachelor’s degree is preferred.

• 4–6 years of experience in healthcare reimbursement is required.

• Proven experience and knowledge of healthcare claims processing, including Medicaid, Medicare, Commercial Insurance, ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, and related areas.

• Experience in healthcare auditing and the review and validation of claims data and claims payment is preferred.

• Familiarity with published healthcare guidelines such as CMS regulations and coding guidelines applied to healthcare claims data.

• Recovery audit experience is preferred.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Fully remote work environment.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.