Medical Claims Analyst

We are looking for an experienced Medical Claims Analyst to support Medicaid billing operations for a long-term contract opportunity in Cleveland, Ohio. This position focuses on claims-related analysis, authorization workflows, and eligibility validation to help maintain accurate billing and reimbursement activity. The ideal candidate brings strong Medicaid expertise, confidence working with 270/271 transactions, and the ability to interpret reporting data in a fast-paced onsite environment.

Responsibilities:
• Review Medicaid-related claims activity and analyze billing information to support timely and accurate reimbursement.
• Manage pre-authorization and payer authorization processes, ensuring required approvals are secured before services are billed.
• Generate, interpret, and reconcile 270/271 eligibility and response reports to confirm coverage and support service reauthorization.
• Examine post-submission billing results to identify claim issues, track denials or rejections, and recommend corrective action.
• Validate member eligibility data for Medicaid billing and maintain accurate supporting documentation for claims processing.
• Assist with reauthorization workflows for ongoing services by using eligibility and transaction data to confirm continued coverage.
• Provide reporting support related to Medicaid billing activity and help organize information needed for limited grant invoicing tasks.
• Work closely with internal stakeholders to resolve billing discrepancies and improve the accuracy of claims-related processes.

Qualifications:

• 5+ years of experience in medical claims, medical billing, or Medicaid-focused revenue cycle work.
• Strong hands-on knowledge of Medicaid billing regulations, claims workflows, and authorization requirements.
• Demonstrated experience working with 270/271 transactions, eligibility reporting, and service reauthorization processes.
• Ability to investigate claim denials, rejected claims, and other reimbursement issues with a high level of accuracy.
• Proficiency in Excel, including PivotTables and VLOOKUP for reporting and data analysis.
• Background in behavioral health billing or claims support is strongly preferred.
• Strong analytical, organizational, and communication skills in an onsite team environment.

Compensation

$27.00-$35.00 Hourly

About Us

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