Healthcare Claims Analyst, SQL & Medicaid/Medicare
Overview
You will own claims reporting and analysis at VillageCare, a New York nonprofit serving chronic care patients, ensuring accurate reimbursement and compliance. Working with SQL, Excel, and Tableau, you will build dashboards and conduct root-cause audits across 45+ years of claims data. You will collaborate with internal teams and third-party administrators to resolve issues and drive policy improvements. This role stands out for its direct impact on operational efficiency and leadership decision-making.
What You'll Do8
- 1Build SQL queries to extract and analyze claims data for reimbursement accuracy.
- 2Design Excel dashboards and Tableau visualizations to highlight claims trends for management.
- 3Audit claims processing against Medicaid and Medicare guidelines to detect gaps.
- 4Perform root cause analysis on claims errors, working with TPAs and internal teams to resolve issues.
- 5Communicate contract and trend issues to management through narratives and visual aids.
- 6Coordinate cross-departmental workflows to ensure compliance with regulations.
- 7Evaluate claims system coding to validate pricing and improve operational efficiency.
- 8Contribute to policy development and quality assurance measures for claims processing.
Requirements9
- 13-5+ years in business intelligence and analytics, focusing on healthcare claims reporting.
- 2Advanced SQL coding experience for data extraction and reporting.
- 3Advanced Excel skills for dashboard and report creation.
- 4Knowledge of ICD-10, CPT, HCPCS, and CMS guidelines.
- 5Familiarity with EncoderPro for coding validation.
- 6Bachelor's degree in Computer Science, Mathematics, Statistics, or Engineering; Master's preferred.
- 7Experience with Tableau and Access for data analysis and visualization.
- 8Ability to work independently with high productivity and advanced communication skills.
- 9Must reside in NY, NJ, or CT.
Salary Insight
$65 - $72k per year
Similar open positions
Explore active roles that match your skills and interests.
Memorial Sloan Kettering Cancer Center
VerifiedRevenue Analytics Specialist - Healthcare Analytics
You will own revenue cycle analytics for Memorial Sloan Kettering Cancer Center, turning complex healthcare data into action for Finance, Revenue Cycle, and Operations. You will build dashboards and reports that improve financial outcomes, working with Tableau and SQL on large datasets. Your insights will shape decisions across the organization, backed by a team of data professionals. This role offers direct impact on cancer care financial health, with hybrid flexibility in NYC.
Acacia Network
VerifiedDenial Analyst, Medical Billing & Third Party Claims
You will own third-party insurance billing and denial reconciliation for Acacia Network's integrated care nonprofit. Working with NextGen, EPACES, and managed care portals, you'll process 837/835 transactions, review EOBs, and resolve claim denials. Reporting to the Director of Revenue Cycle, you'll join a team serving behavioral and primary healthcare across NY, FL, and PR. This role puts you at the core of revenue integrity in a mission-driven organization.
Oscar Health
VerifiedData Analytics Associate, Healthcare Operations
You will own insights generation for a major business unit at Oscar Health, partnering with senior managers to drive data-informed decisions. You'll use SQL to extract and analyze large datasets, build robust data models, and create dashboards in Looker to track financial and utilization metrics. You'll collaborate across the organization, presenting findings to leadership and identifying opportunities to reduce healthcare inefficiencies. This role offers the chance to work with Python or R and dbt in a hybrid schedule based in New York City.
ExpressCare Urgent Care
VerifiedMedical Claims Analyst ExpressCare Urgent Care Baltimore
Own end to end processing of unpaid and rejected claims for government commercial and workers compensation payers. Monitor claim status through insurer portals and provider systems. Resolve rejections and resubmit through clearinghouse. Report daily claim activity to Claims Specialist. Analyze rejection patterns and communicate findings to leadership. Ensure all submissions meet payer requirements. Handle patient payment collections and answer billing inquiries. Work in a fast paced environment at our Bel Air location.
Talent Solution Partners
VerifiedField Healthcare Network Development Rep - Queens/Bronx
You will own provider network growth and performance across Queens and Bronx, managing 30-50% local travel to drive value-based care adoption. You'll serve as the strategic liaison between the healthcare client and contracted providers, building C-Suite relationships and influencing long-term network strategy. This role stands apart through its focus on HEDIS metrics and VBP initiatives, with direct mentorship responsibilities and high autonomy. You'll report to the Head of Provider Engagement and collaborate with clinical and operational teams to transform provider performance.
PRICE WATERHOUSE COOPERS
VerifiedPayer Healthcare Data Scientist Manager | PwC
You will own advanced data science and machine learning projects on large-scale claims and clinical data for payer clients. You will lead teams, manage client accounts, and deliver insights that reduce cost of care and improve population health. Working with Python, R, and SQL, you will build analytics products and collaborate with industry leaders. This role offers direct impact on healthcare strategies and mentorship of junior staff.