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Health Admin Services Senior Analyst

Accenture • Charlotte, NC, US • published 2026-10-18 08:19:22.243845

Description

The Health Operations Senior Analyst supports the accuracy and effectiveness of healthcare claims editing and auditing processes. This role reviews edit and audit groupings to help ensure the appropriate application of codes, criteria, modifiers, and claim dispositions in alignment with customer policies and requirements. The Senior Analyst researches medical policies, investigates complex claims and editing issues, and collaborates with customers and internal teams to identify solutions. The role also supports claims processing, customer auditing programs, and the development and maintenance of work instructions and other operational documentation. In this role, you will: * Analyze complex healthcare claims, editing, and auditing issues and recommend appropriate resolutions. * Review claims edits and audit groupings for accuracy, including applicable codes, criteria, modifiers, and dispositions. * Research medical, reimbursement, and customer policies to determine their impact on claims edits and audits. * Evaluate claims processing issues and identify potential causes, impacts, and solutions. * Work collaboratively with customers, operational teams, and other stakeholders to reso...

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