HealthCare Claims Analyst

Village Care•New York, NY

7d•$58,039 - $65,294•Hybrid

About The Position

Join VillageCare as a Full-Time HealthCare Claims Analyst and take your career to the next level while working from the comfort of your home. With a competitive salary range of $58,039.46 to $65,294.40, this position offers great financial incentives while allowing you to maintain a flexible work-life balance through hybrid schedule. At VillageCare in New York, NY, you will have the opportunity to contribute to a forward-thinking organization that emphasizes customer-centric solutions and excellence in healthcare. You will be part of an energetic team that values problem-solving and integrity, empowering you to drive meaningful change in the industry. You will be given great benefits such as Medical, Dental, Vision, Life Insurance, Health Savings Account, Competitive Salary, and Paid Time Off. This role not only enhances your professional skills but also places you at the heart of a mission-driven environment focused on making a positive impact in healthcare. Apply today to be part of our dynamic team! VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. The Full-Time HealthCare Claims Analyst position at VillageCare requires a seasoned professional with a minimum of five years of experience in healthcare claims reporting and processing, alongside in-depth knowledge of Medicaid and Medicare guidelines. The ideal candidate should possess advanced SQL coding and Excel skills to create insightful reports and dashboards. You will play a critical role in 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). This position involves identifying gaps in various aspects of claims processing, communicating trends and contract issues to management, and preparing comprehensive narratives and visual aids for leadership presentations. You will also coordinate workflows across departments, ensure compliance with regulations, and contribute to the development of policies and quality assurance measures. Your analytical skills will be essential in evaluating claims system coding to validate pricing and improve overall operational efficiency.

Requirements

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
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, along with 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

Nice To Haves

Master's degree preferred

Responsibilities

Understanding healthcare reimbursement from both financial and operational perspectives
Conducting audits
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