Clinical Billing and Claims Analyst II

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!

This role is responsible for processing and managing claims, supporting operational improvements in revenue cycle processes, and ensuring accurate and timely client invoicing. This role handles claim documentation, analyzes complex revenue data, conducts insurance eligibility checks, and collaborates with multiple departments to enhance billing accuracy and compliance. The position also involves reconciling accounts, auditing internal controls, and providing leadership in project work as needed.

This role…

• Claims Processing and Accuracy: Review and process claims to ensure documentation is complete and accurate. Verify claim eligibility and apply policy guidelines, escalating complex issues as necessary.

• Insurance Eligibility Verification: Conduct monthly and ongoing insurance eligibility checks for all program members, including new enrollments, to support accurate claims and billing.

• Client Invoicing and Revenue Management: Ensure timely, accurate invoicing and participate in accounts receivable collection efforts. Use data analysis to provide insights into client payments, utilization, and revenue trends.

• Reconciliation and Auditing: Perform account reconciliations to resolve discrepancies, participate in internal/external audits, and maintain documentation of internal controls, ensuring SOX compliance where applicable.

• Operational Improvement: Identify and implement process enhancements, contribute to system modifications, and participate in strategic initiatives. Develop and document process flows to optimize billing and claims operations.

• Fraud Detection and Compliance: Report suspected fraudulent claims to appropriate departments and ensure compliance with policies. Conduct claims reviews to address potential fraud, waste, or abuse.

• Collaboration and Communication: Work closely with internal departments, providers, and clients to gather information, resolve claim and billing inquiries, and improve customer service.

• Project Leadership: Lead projects related to claims and billing improvements, facilitate workgroup meetings, and oversee complex software implementations.

• May lead projects and perform other duties as assigned.

• Occasional business travel may be required.

We are interested in speaking to individuals with the following…

• Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field preferred.

• Three (3) plus years of experience in claims processing, billing, or a related role within a healthcare or data-driven environment.

• Or equivalent combination of education and/or experience.

• Strong analytical and problem-solving skills, with the ability to interpret and manage large datasets effectively.

• Advanced proficiency in Microsoft Excel (e.g., pivot tables, formulas, v-lookups) and experience with SQL or other data analysis tools.

• Deep understanding of healthcare billing standards, insurance claims processing, and compliance regulations (SOX preferred).

• Strong attention to detail and ability to conduct thorough audits, reconciliations, and fraud detection reviews.

• Effective project management skills, with the ability to lead initiatives, oversee software implementations, and drive process improvements.

• Excellent verbal and written communication skills, capable of engaging with internal teams, clients, and external stakeholders.

• Ability to work independently and make data-driven decisions, ensuring compliance with company policies and industry regulations.

• Strong organizational and time management skills, capable of handling multiple priorities in a fast-paced environment.

• Customer-focused mindset, with the ability to resolve claims and billing inquiries efficiently and professionally.

• High level of learning agility and adaptability, with a proactive approach to staying updated on industry changes and process improvements.

• Strong collaboration and teamwork skills, fostering positive working relationships across departments.

Salary: $52,900.00 - $71,400.00

Modivcare’s positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received.  We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. 

We value our team members and realize the importance of benefits for you and your family.

Modivcare offers a comprehensive benefits package to include the following:

• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

Modivcare is an Equal Opportunity Employer.

• EEO is The Law - click here for more information
• Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
• We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. If you need assistance, please reach out to us at hr.recruiting@modivcare.com