Healthcare Claims Analyst (Hybrid)

Healthcare Claims Analyst

Location: Midlothian, Virginia | Hybrid
Reports to: Director of Compliance
Classification: Non-Exempt

Accessia Health is a national nonprofit organization dedicated to supporting individuals living with rare and chronic medical conditions. We operate in a highly regulated healthcare environment and are committed to operational excellence, compliance, and mission-driven service.

Position Summary

The Healthcare Claims Analyst reviews and processes patient assistance claims to ensure accuracy, completeness, and compliance with established policies and program requirements. This role verifies eligibility, reviews supporting documentation and medical codes, calculates reimbursement amounts, and supports timely payments to patients and healthcare providers.

This position does not supervise staff and follows a hybrid schedule, working onsite Tuesday through Thursday and remotely on Monday and Friday.

Essential Functions

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

• Review patient assistance claims, explanations of benefits, and healthcare claim forms for accuracy and completeness.

• Verify patient eligibility and account information against program requirements.

• Analyze CPT and ICD-10 codes to ensure claims align with documented services.

• Calculate and process reimbursement amounts in accordance with established policies and procedures.

• Identify, document, and escalate claim errors or discrepancies for resolution.

• Communicate with providers, patients, and payees to obtain required documentation.

• Respond to internal questions regarding claims status, documentation, and payment timelines.

• Maintain accurate claims records and protect sensitive information in accordance with HIPAA and organizational confidentiality standards.

• Identify recurring issues and share recommendations for process improvement.

• Support compliance audits and quality reviews and maintain current knowledge of program guidelines and applicable regulatory requirements.

Minimum Qualifications

• At least five years of experience in medical claims processing, analysis, or reimbursement.

• Working knowledge of medical terminology, CPT, and ICD-10 coding.

• Familiarity with healthcare billing regulations and compliance standards.

• Strong attention to detail, accuracy, and analytical problem-solving skills.

• Ability to consistently follow established procedures.

• Effective written and verbal communication skills.

• Ability to manage multiple priorities and meet deadlines.

Preferred: Medical coding certification, such as Certified Medical Coder (CMC).

Employment Requirements

• Must reside in the Commonwealth of Virginia at the time of hire and throughout employment.

• Must be able to meet the position's onsite work requirements.

• Must be authorized to work in the United States.

• No employment visa sponsorship is available for this position.

Compensation & Benefits

Compensation is commensurate with experience and internal equity considerations.

Accessia Health offers a comprehensive benefits package, which may include:

• Medical, dental, and vision coverage

• Employer-paid life and disability insurance

• 401(k) retirement plan with employer contributions, subject to plan terms and eligibility requirements

• Paid time off and holidays

Benefits are provided in accordance with plan documents and eligibility requirements.

Accessia Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, and gender identity), national origin, age, disability, veteran status, or any other status protected under applicable law.