Senior Analyst, Health Care Quality Management, Medicaid - Remote

Overview

This role involves managing health plans to ensure compliance with clinical and regulatory guidelines, focusing on claims and policy support in the health care industry.

In Short

• Manage up to four health plans for compliance.
• Coordinate claim editing and clinical program enhancements.
• Provide support for savings opportunities and vendor implementation.
• Must have RN or LPN qualifications.
• 3-5 years of experience in health care claims support.
• Excellent communication skills required.
• Experience in root cause analytics and claim validation.
• Familiarity with claim editing software is necessary.
• Preferred: Certified Coder or commitment to obtain CPC certification.
• Work from home position based in the USA.

Requirements

• RN or LPN qualification.
• 3-5 years of relevant experience.
• Strong verbal and written communication skills.
• Experience with claim analytics.
• Familiarity with claim editing software.
• Preferred: QNXT Claim System experience.
• Commitment to obtain CPC certification.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company matching.
• Employee stock purchase plan.
• No-cost wellness programs.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave options.
• Confidential counseling and financial coaching.