Medical Claims Analyst

Description We are looking for a detail-oriented Medical Claims Analyst to support audit activities, payment reviews, and compliance evaluations for Medicaid-related claims in Charlotte, North Carolina. This Long-term Contract opportunity is ideal for someone who can examine claim activity carefully, interpret regulatory standards, and contribute to accurate audit outcomes. The role requires strong analytical thinking, clear documentation practices, and the ability to help resolve claim and payment issues through structured review and reporting.

Responsibilities:

• Review provider records and claims activity to assess billing accuracy and identify payment discrepancies.
• Conduct validation testing on medical and Medicaid claims to confirm compliance with applicable policies and reimbursement guidelines.
• Analyze denied, rejected, and disputed claims to determine root causes and support appropriate resolution steps.
• Prepare organized audit workpapers, supporting analyses, and written summaries of findings for internal review.
• Interpret Medicaid rules and relevant federal guidance when evaluating claim transactions and provider payment practices.
• Assist with compliance-focused examinations related to program integrity and recommend corrective actions when issues are identified.
• Collaborate with stakeholders to address audit questions, clarify documentation, and support follow-up on outstanding findings. Requirements
• Experience reviewing medical claims, billing records, and reimbursement data in a healthcare or Medicaid environment.
• Working knowledge of claim denials, rejected claims, and processes used to research and resolve payment issues.
• Familiarity with Medicaid regulations and compliance standards related to claims review and audit activity.
• Ability to document findings accurately and prepare clear supporting analysis for audits or payment validation reviews.
• Strong analytical skills with attention to detail and the ability to identify inconsistencies in claim documentation.
• Proficiency in medical billing concepts, claims terminology, and standard audit or review practices.
• Effective written and verbal communication skills to explain findings and support issue resolution.

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