Senior Health Claims Analyst - Large Claims Expert (Philadelphia)

Job Posting

Highlight Health is a mission-driven company that protects consumer rights and controls healthcare costs exclusively for self-funded employers and their stop loss carriers. We are a profitable, fast-growing company without private equity investors.

We are looking for a health coverage large and complex claims analysis expert an expert who has scrutinized hospital and other claims with millions of dollars of charges, knows where the medical billing and pricing skeletons are found, and is tired of business as usual. Your deep knowledge has likely been developed over decades of diverse work with a claims repricing organization, a claims audit department or organization, special investigations unit (SIU), and / or an Office of the Inspector General (OIG).

Highlight Health engineers new ways to protect consumer rights and control healthcare costs for self-funded employers. Nearly every American has felt the pain of the skyrocketing cost of healthcare. Highlight Health brings them solutions. We use our subject-matter expertise to reduce costs for employers and relieve ordinary Americans of burdensome medical costs. Highlight Health is proud of its inclusive workplace that brings together highly skilled leadership and employees from all walks of life. Our company is headquartered in two cities along the Northeast Corridor with an affordable cost of living : Philadelphia, PA and Newark, NJ.

If you are experienced in and passionate about fighting fraud, waste, and abuse in medical billing, this is the job for you. We are seeking a motivated and hard-working individual to guide and optimize the most crucial department of our businessclaims analysis and resolutions. In addition to an extensive background in medical billing and claims analysis, this role requires strong communication skills, both written and verbal, and organizational aptitude. The ability to prioritize and satisfy deadlines in this position is a must.

Essential Duties and Responsibilities :

• Analyze large and complex claims that need special attention
• Comprehensively review claims for fraud, waste, abuse, and overpayment
• Manage ad hoc Medicare pricing using APC
• Read, understand, and analyze comprehensive medical records and itemized bills
• Make and present claim resolution recommendations to manager or executive leadership
• Complete the claims resolution process
• Help Highlight Health improve claims analysis and resolution processes