Health Care Claims Analyst
Myers and Stauffer LC

Job Info

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Myers and Stauffer LC is a certified public accounting and health and human services consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health and human services programs (primarily state Medicaid agencies, and the federal Center for Medicare & Medicaid Services). We have 45+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 20 offices and have over 900 associates nationwide.

At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government health and human services clients that focus on those in need. We are committed to providing our employees with professional growth and development opportunities, a diverse, dynamic, challenging work environment, and a strong and visionary leadership team.

What We Offer:

• Health, Dental, and Vision insurance along with other competitive employee benefits
• Vacation time, sick time, paid holidays, and two floating holidays
• Paid Parental Leave and available support resources
• 401K with company matching for eligible employees
• Tuition reimbursement, referral bonuses, paid volunteer community service time, mentor program, and a variety of other employee programs and perks
• A combination of technical and leadership development training at each career milestone
• Up to six counseling sessions per year for eligible employees through our Employee Assistance Program

The Health Care Claims Analyst will play an important role in our multi-disciplinary team. This position focuses on data analytics and project coordination, requiring SQL proficiency for healthcare claims analysis, along with project management, report writing, and client communication skills. You will assist in identifying potential fraud, waste, or abuse of Medicaid or other healthcare funds, conducting reimbursement analyses, and supporting the presentation of findings to clients in clear, concise formats.

Essential Functions:

• Use SQL to review and analyze healthcare provider claims to determine if overpayments or underpayments have occurred in accordance with applicable policies.
• Assist in managing project tasks and timelines, and serve as a supporting point of contact with clients and healthcare providers. Provide clear and accurate updates on project progress to team leads and clients.
• Draft comprehensive reports and provider notification letters summarizing your findings and recommendations for corrective action based on data analysis.
• Develop a deep understanding of Medicaid and other payer regulations, billing manuals, and reimbursement policies. Conduct research to ensure compliance with billing and coding standards.
• Assist in conducting audits related to Medicaid and healthcare reimbursement, focusing on identifying potential fraud, waste, and abuse. Support in preparing well-researched and documented findings for internal review and client presentation.
• Participate in client meetings and handle questions from providers, communicating findings and recommendations in a professional and approachable manner.
• Work closely with team members, contributing to project tasks and supporting overall team efforts. Ensure the confidentiality and security of protected health information.

Requirements:

• Bachelor's degree in Health Information Administration, Health Informatics, Healthcare Management, Data Science, or a related field. A postgraduate degree is a plus.
• SQL proficiency is strongly preferred, with experience in working with large healthcare datasets.
• 1-2 years of experience in healthcare data analysis or related fields, preferred.
• Strong written and verbal communication skills, with experience in client interaction and report writing.
• Organized, detail-oriented, and self-motivated, with the ability to effectively manage tasks and meet deadlines while balancing multiple projects.
• Knowledge of healthcare data privacy regulations.
• Certifications such as CFE, AHFI, CHDA, CPMA, RHIT, or RHIA.
• Experience in data mining, statistical analysis, or fraud detection methodologies.
• Familiarity with Medicaid or government healthcare programs.

The Team:
Myers and Stauffer takes pride in the welcoming and collaborative culture we have throughout our offices. For this position, the employee will report to one of our Managers or Senior Managers on the Cost Report/DSH engagement team.

Work Style:
Our general business hours are Monday through Friday 8am-5pm, but can vary based on business needs. Dependent on performance, our in-office associates are eligible for a hybrid work schedule after their initial 90-day training period. As a company, we are always willing to discuss potential flexibility that an employee may need to better suit their work-life wellbeing.

Typical Interview Process:

• Phone Screen with a Recruiter
• In person or remote interview with the hiring manager & team
• Hiring decision and job offer

We understand that changing or learning a new industry can discourage strong candidates from applying. Myers and Stauffer is committed to investing in your career development and providing the necessary resources to help you succeed. Please do not hesitate to apply, as you may be the right fit for this position or another position we have open.

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