Duration: Expected to be 03-06 months contract with possible extensions.

Location: Alpharetta, GA 30022 (ONSITE)

Pay Range: $20/hr.-$30/hr. The pay rate may differ depending on your skills, education, experience, and other qualifications.

Featured Benefits:

• Medical Insurance in compliance with the ACA
• 401(k)
• Sick leave in compliance with applicable state, federal, and local laws

Job Description:

•  We are seeking a meticulous and experienced Healthcare Claims Analyst to join our team.
• The ideal candidate will have a strong technical background, experience with automated claims administration systems, and the ability to oversee both medical and prescription claims.

Responsibilities:

• Analyze and process healthcare claims, including medical and prescription claims, ensuring accuracy and compliance with policies and regulations.
•  Oversee the end-to-end claims process, from submission to resolution, identifying and addressing any discrepancies or issues.
• Utilize automated claims administration systems to manage and process claims efficiently.
• Collaborate with healthcare providers, insurers, and other stakeholders to resolve claim disputes and ensure timely payment.
• Conduct regular audits and reviews of claims to ensure compliance with regulatory requirements and internal policies.
• Generate and analyze reports on claims activity, identifying trends and areas for improvement.
• Provide technical support and training to team members on the use of claims administration systems.
• Stay updated with changes in healthcare regulations and claims processing guidelines.
• Assist in the development and implementation of policies and procedures to enhance claims processing efficiency and accuracy.

Required Qualifications:

•  Education: Bachelor’s degree in Healthcare Administration, Business Administration, Information Technology, or a related field.
• Experience: 3 years of experience in healthcare claims processing, with a focus on both medical and prescription claims.

Technical Skills:

•  Proficient in using automated claims administration systems (e.g., Facets, HealthEdge, Trizetto).
• Strong understanding of healthcare claims processing, including coding (ICD-10, CPT, HCPCS) and billing procedures.
• Experience with claims auditing and compliance.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint).
•  Familiarity with database management and reporting tools (e.g., SQL, Tableau).
• Understanding of healthcare regulations and guidelines (e.g., HIPAA, CMS).

Preferred Qualifications:

• Additional Skills:
•  Experience with data analysis and reporting.
• Knowledge of healthcare payer operations and provider networks.
• Familiarity with electronic data interchange (EDI) processes.
•  Certification in claims processing or healthcare administration (e.g., AAPC, AHIMA).

Soft Skills:

• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.
•  Effective communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Strong organizational and time management skills.
• Ability to manage multiple tasks and prioritize effectively.
• Continuous learner with a proactive approach to improving processes.