Medical Claims Analyst Job at Robert Half (Baton Rouge)

Senior Associate Medical Data Analyst

The Senior Associate Medical Data Analyst will play a pivotal role in supporting...

Location

India , Hyderabad

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

PhD in Computer Science, Engineering, Mathematics, Healthcare or a related field and 1+ year(s) of Medical Data Analytics, Commercial Data Analytics, Primary Market Research, Performance Reporting or related experience
Master’s degree in Computer Science, Engineering, Mathematics, Healthcare or a related field and 3+ years of Medical Data Analytics, Commercial Data Analytics, Market Research, Performance Reporting or related experience
Bachelor’s degree in Computer Science, Engineering, Mathematics, Healthcare or a related field and 5+ years of Medical Data Analytics, Commercial Data Analytics, Market Research, Performance Reporting or related experience

Job Responsibility

Translate complex analytical findings into clear, data-driven recommendations that enhance MSL engagement strategies and contribute to improved patient outcomes
Conduct data analysis across structured and unstructured datasets including but not limited to HCP sentiment, scientific engagement data, and publications
Design, develop, and maintain dashboards, reports, and visualizations to track performance, measure outcomes, and identify actionable trends using Python, R, SQL, Tableau, Power BI, or similar platforms
Understand pharmaceutical ecosystem and data sets including prescription (ex. IQVIA NPA), outlet (ex. IQVIA DDD), Lab as well as medical and pharmacy claims (ex. Symphony Claims.)
Establish and track KPIs to assess analytics impact and ensure alignment with business goals
Develop and deliver ad hoc data analyses that distill complex medical data into clear, actionable insights for stakeholders
Develop reusable code components, templates, and frameworks to support analytics scalability and lifecycle management
Collaborate with data science, IT, engineering, and external partners to ensure data access, integrity, governance, and seamless integration across platforms and systems
Contribute to Agile development workflows by collaborating in sprint planning, refining user stories, and delivering iterative analytics solutions aligned with business priorities
Continuously evaluate and introduce advanced techniques in visualization, predictive analytics, and automation

Prescription Plan Design Escalations Analyst

Responsible for internal and external functions that support accurate claim proc...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

Experience in pharmacy or medical field (Level 1 – 3 years
Levels 2 and 3 – 5 years
Level 4 – 6 years)
Experience in prescription benefit administration (Level 1 – 1 year
Level 2 - 3 years
Level 3 – 5 years
Level 4 – 6 years)
Experience working in vendor applications (rebate, web tools, formulary tools) (Level 2 – 1 year
Level 3 – 2 years
Level 4 – 5 years)

Job Responsibility

Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
Support internal and external customers with information on benefits applicable to medication claims
Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
Communicate recommendations in regard to medication claim processing and benefit decisions
Monitor and investigate reported plan set up system issues
Participates in quality initiatives
including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested
Resolve escalated member issues
Research & provide recommendations for accumulations issues

Fulltime

Senior Manager of Business Intelligence

As a Senior Manager of Business Intelligence for the Quality zone, you will be a...

Location

United States , Bethesda

Salary:

Not provided

Aledade, Inc.

Expiration Date

Until further notice

Requirements

10+ years of experience in business intelligence
3+ years of managerial experience
Deep expertise in healthcare quality measurement, with a strong understanding of frameworks such as NQF, eCQMs, MA STARs, HEDIS, and MIPS
Proven track record of partnering with senior and executive-level stakeholders to translate complex clinical/quality business needs into a strategic, actionable analytics roadmap
Specific experience managing or overseeing MSSP Quality Reporting and MA STARs performance data
Expert-level proficiency in SQL and deep, hands-on experience with a modern data stack, including Snowflake for data warehousing, dbt for data transformation, and Tableau for data visualization
Extensive experience analyzing complex healthcare data (e.g., medical claims, EHR, clinical registries) within a value-based care framework
Exceptional communication and storytelling skills, with the ability to distill complex analytical findings into clear, actionable insights for a wide range of audiences, including executive leadership
Expertise in data warehousing principles and scalable data modeling concepts to build robust, foundational data solutions
Proven ability to lead an analytics team within an agile framework, effectively managing team sprints, backlogs, and project roadmaps

Job Responsibility

Drive Strategic Impact (25%): Act as a key strategic partner to senior leaders within the Quality and Clinical domains. Translate evolving regulatory and clinical needs into a clear technical roadmap, delivering analytics that measure MSSP and MA STARs performance, demonstrate clinical value, and drive patient health outcomes
Develop & Mentor Your Team (25%): Manage, coach, and develop a high-performing team of individual contributors, including leads and senior analysts. Foster a respectful and supportive environment where team members can grow, providing regular feedback, career mentorship, and opportunities for development
Champion Excellence & Collaboration (20%): Lead your team in agile processes, anticipating and mitigating roadblocks. Promote a "one team" mentality through cross-functional partnership, ensuring tight alignment with Payer & Network BI Zones to ensure Data for Good measures (e.g., diabetes care) are integrated into broader company performance views
Own the BI Vision & Roadmap (15%): Take full ownership of the BI roadmap and quarterly planning for the Quality domain. Work closely with key stakeholders on strategy, demand management, and prioritization to ensure the team is delivering the most valuable data products for regulatory reporting and clinical improvement
Deliver Actionable Insights (15%): Oversee the development of interactive dashboards, executive-level reports, and presentations that clearly communicate insights on Quality measurement, gap-closure opportunities, and the efficacy of clinical programs

What we offer

Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options

Fulltime

Revenue Cycle Analyst

We are looking for a skilled Revenue Cycle Analyst to join our team on a contrac...

Location

United States , Tulsa

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma with at least 2 years of relevant experience, or Associate's/Bachelor's degree, or 4 years of applicable experience
Preferred 1-3 years of experience in revenue integrity, revenue cycle operations, or related fields
Familiarity with healthcare revenue cycle processes, medical billing, and claims
Strong analytical skills with experience in business and data analysis
Ability to work collaboratively with cross-functional teams and management
Knowledge of billing functions and revenue cycle informatics
Excellent communication skills to present findings and recommendations clearly
Proficiency in using relevant software and tools for reporting and analysis

Job Responsibility

Conduct daily tasks related to maintaining revenue integrity, ensuring compliance with organizational standards
Research and develop educational content for training programs focused on revenue integrity
Analyze and review revenue processes, presenting findings and recommendations for corrective actions
Collaborate with management teams to oversee and update the charge description master
Provide ongoing support for charge capture activities, including maintaining workflows and reporting for clinical departments
Act as a subject matter expert on revenue integrity issues, offering guidance on operational and organizational concerns
Track and report on the progress of revenue integrity initiatives, including status updates and reimbursement analysis
Create and maintain detailed reports related to charge capture and revenue processes
Assist in the implementation of improvements to optimize revenue cycle efficiency

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Revenue Cycle Analyst

This Contract to permanent position offers an exciting opportunity to play a cri...

Location

United States , Wichita

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor's degree with at least 1 year of relevant experience, or 3 years of cumulative job-specific experience
Minimum of 3 years of experience in revenue integrity, revenue cycle operations, hospital coding, surgical nursing, or revenue cycle informatics
Familiarity with healthcare revenue cycle processes, medical claims, and billing functions
Strong knowledge of medical coding standards, including ICD-10-CM codes
Proven ability to analyze data and identify trends for quality improvement
Experience providing leadership, training, and support to teams
Detail-oriented with excellent organizational and auditing skills

Job Responsibility

Collect and analyze data from multiple sources to create detailed reports and statistical insights
Develop the scope and format of reports, ensuring they meet organizational needs and standards
Prepare and manage ad hoc management reports to support decision-making processes
Provide guidance, training, and mentorship to staff on accessing reports and interpreting data effectively
Identify trends in data and recommend strategies for enhancing quality and efficiency
Maintain and support reporting processes related to charge capture activities, including clinical workflows
Review and reconcile clinical documentation, surgical logs, and nursing records to ensure accurate coding and charge assignments
Conduct audits and reconciliations of electronic health records to confirm accurate billing and documentation compliance
Collaborate with clinical departments to ensure proper workflows and adherence to coding standards

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Coding Analyst

The Claims Coding Analyst’s primary responsibilities require independent judgeme...

Location

United States , Lake Mary; New York

Salary:

61300.00 - 99120.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA)
High school diploma or GED from an accredited institution

Job Responsibility

Conducts independent assessments of current claims edits
Proactively identifies areas of opportunity with respect to new edits, modifications to existing edits, and recommended claims policy changes
Leads implementation efforts with respect to new or modified edits
Monitors and reports on performance of current claims editing packages
Serves as a subject matter expert to defend claims payment policy disputes and appeals
Reviews claims editing escalated provider disputes/appeals and provides guidance on coding rules and industry standards
Researches and provides feedback on claims editing performance issues
Collaborates with claims editing vendors to maintain and update edits
Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines
Leads continuous improvement and quality initiatives

What we offer

Medical, dental and vision coverage
Incentive and recognition programs
Life insurance
401k contributions

Fulltime

Revenue Cycle Analyst

This contract-to-permanent position offers the opportunity to contribute to a dy...

Location

United States , Addison

Salary:

38.00 - 42.00 USD / Hour

Robert Half

Expiration Date

Until further notice

Requirements

At least 5 years of experience in healthcare revenue cycle operations, including medical billing and claims processes
Proficiency in managing insurance denials and accounts receivable follow-up
Strong familiarity with revenue cycle processes, KPI reporting, and billing functions
Knowledge of strategic pricing and reimbursement practices in a hospital setting
Experience working with Cerner Sorian or similar systems is preferred
Exposure to environments such as Supply Chain, Clinical Operations, Coding, or General Ledger
Bachelor’s degree is preferred but not required
Ability to document processes and ensure compliance with industry standards

Job Responsibility

Oversee daily revenue integrity operations to ensure precise and compliant charge capture
Develop and deliver training programs focused on best practices in revenue integrity
Conduct detailed reviews of revenue processes and provide actionable recommendations to leadership
Collaborate with Charge Description Master management teams to maintain and update charge master systems
Create and manage analytics tools to monitor charge capture activities and departmental compliance
Stay informed on regulatory and legislative changes, adapting revenue integrity programs as needed
Partner with departments like Supply Chain, Coding, and Finance to enhance revenue recognition and charge optimization
Support pricing and reimbursement strategies through data-driven analysis and recommendations
Maintain dashboards to track revenue integrity metrics, initiative progress, and reimbursement trends
Act as a subject matter expert, providing guidance and support to staff on revenue integrity operations

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Revenue Cycle Analyst

This role is critical in ensuring the accuracy and compliance of revenue operati...

Location

United States , Oak Brook

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 5 years of experience in healthcare revenue cycle operations
Strong knowledge of medical billing, claims processing, and insurance denial management
Familiarity with key revenue cycle processes, including KPI reporting and billing functions
Experience with Cerner Sorian systems or similar healthcare platforms is preferred
Exposure to environments such as Supply Chain, Clinical Operations, Coding, or General Ledger
Bachelor’s degree in a relevant field is preferred
Strategic pricing and reimbursement expertise is highly desirable
Proven ability to document processes and ensure compliance with healthcare standards

Job Responsibility

Ensure daily revenue integrity activities, including accurate and compliant charge capture processes
Research and design training programs to educate staff on best practices for revenue integrity
Conduct detailed reviews of revenue processes, presenting findings and recommending actionable improvements to leadership
Collaborate with Charge Description Master teams to maintain and update charge master systems
Develop performance reports and analytics to monitor charge capture activities and departmental compliance
Stay informed on regulatory changes affecting reimbursement and adjust revenue integrity strategies accordingly
Partner with departments such as Supply Chain, Clinical Operations, and Finance to enhance charge capture and revenue recognition
Provide insights and recommendations for strategic pricing and reimbursement initiatives based on thorough data analysis
Maintain dashboards to track revenue integrity efforts, compliance trends, and financial performance
Act as a subject matter expert to support staff in navigating operational and financial challenges related to revenue processes

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Medical Claims Analyst

Robert Half

Location:
United States , Baton Rouge

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 22, 2026

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Location:United States , Baton Rouge

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Job Description:

Job Responsibility:

Requirements:

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