Job Description
Description We are looking for a Medical Claims Analyst to join our team in Raleigh, North Carolina on a Contract to permanent basis. This position is ideal for a detail-oriented individual who can evaluate Medicaid-related claims activity, support audit initiatives, and help maintain compliance with healthcare payment standards. The role offers the opportunity to work independently on analytical reviews while partnering with internal teams to strengthen accuracy, documentation, and regulatory alignment.
Responsibilities:
• Review provider records and claims activity to assess payment accuracy and identify discrepancies requiring follow-up.
• Perform audit procedures tied to Medicaid claims, billing practices, denials, and rejected claims to support program integrity efforts.
• Interpret Medicaid rules and applicable federal guidance when evaluating findings and determining compliance outcomes.
• Prepare organized workpapers, summaries, and preliminary reports that...
Responsibilities:
• Review provider records and claims activity to assess payment accuracy and identify discrepancies requiring follow-up.
• Perform audit procedures tied to Medicaid claims, billing practices, denials, and rejected claims to support program integrity efforts.
• Interpret Medicaid rules and applicable federal guidance when evaluating findings and determining compliance outcomes.
• Prepare organized workpapers, summaries, and preliminary reports that...