Claims Analyst, Senior Consultant - Mazars USA LLP

Claims Analyst, Senior Consultant

Mazars USA is hiring - If you are looking for a career where you can truly have a say, make an impact, and bevalued, Mazars is the right place for you!

Our Consulting practice seeks an experienced consultative professional to join our Healthcare Consulting team as a Senior Consultant focused on claims analysis as well as regulatory and operational compliance .

This is a national practice and we offer flexible work hours and locations: in office, remote, hybrid.

What You Will Do:

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  Work under the direct supervision of a Director and/or Principal to accomplish assigned project objectives, both independently with guidance and in collaboration with colleagues, through direct work performance.
  
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  As a healthcare claims subject matter expert, project objectives may include performing policy, procedure, workflow and other document review, designing and completing audit testing, conducting interviews, analyzing data, researching criteria and best practices, observing processes, and assessing workflows to develop recommended process improvements, strategies, and written reports and other deliverables, such as training provision, guidance, and coaching.
  
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  Assist the broader team in evaluating functional areas related to claims processing, such as configuration, provider dispute resolution, and utilization management.
  
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  Develop and maintain strong working knowledge of claims regulatory and compliance issues specific to client and project needs, including state and federal regulations and statutes.
  
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  Assist in the preparation of proposals, presentations, and other materials as requested.
  
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  Assist in the development and implementation of the Healthcare Consulting Group's overall marketing strategies, plans and programs, corporate communications, and client strategies and goals as relates to each project.
  
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  Provide consistent and superior customer service to both our clients and internal colleagues.
  
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  Maintain individual compliance with firm administrative duties and applicable professional development requirements and programs, such as continuing professional education requirements, time entry, and expense reporting.
  
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  Perform assigned duties and responsibilities in a professional manner that reflects the firm's style, reputation, and overall goals.

What We Seek:

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  Years+ experience required: 10+ years of claims auditing, analyst, and/or claims management experience with direct knowledge of applicable regulatory and accreditation requirements. Must have State of California Medi-Cal and DMHC Knox Keene Act claims experience. Experience with CMS (Medicare/Medicaid), DHHS OIG, and NCQA preferably within a health plan environment preferred.
  
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  Education required: Bachelors degree or equivalent combination of years of experience and certifications required
  
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  Certification required/preferred: AAPC Certified Professional Coder (CPC) certification required; HFMA Certified Revenue Cycle Representative (CRCR) preferred.
  
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  Skilled in working collaboratively with multiple stakeholders in a complex healthcare environment.
  
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  Experience in Claims Analysis and application of edits for Medicare, Medicaid and Commercial payers for Hospital.
  
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  Knowledge of health insurance payers (Medicare, Medicare Advantage Plans, Commercial plans, MediCal and Medi-Cal HMOs).
  
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  Success and experience working cross-functionally with internal and external teams such as Patient Access, Configuration, Utilization Management, Finance and Revenue Cycle.
  
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  Exceptional writing and editing skills preferred
  
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  Ability to travel to client locations as needed
  
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  Our firm does not anticipate hiring experienced or entry level job seekers who will need sponsorship through the H-1B lottery, now or in the future.
  

Why Mazars:

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  We offer a generous compensation package with discretionary bonus opportunities, paid time off and a 401K plan with a firm matching contribution
  
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  The salary range for this role takes into account many factors including, but not limited to, years and type of experience, skill sets, and certifications. The projected salary range for this position is $90,000- $145,000.
  
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  We are committed to diversity, in all of its forms, in our workforce
  
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  We are committed to work/life balance, offering a flexible "Dress for Your Day" dress code and summer Fridays "kickstart" program
  
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  We are committed to the values inherent in making ESG (environmental, social and governance) a priority in everything we do -- to being a firm that's responsible to our employees, clients, society and our planet
  
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  Mazars offers a wide range of mentoring, training and professional development opportunities to support you in reaching your fullest potential
  
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  We offer a graduate school support program and tuition reimbursement
  
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  We offer international rotation opportunities with the Mazars Group of member firms in Europe, Asia Pacific, the Middle East, Africa, Latin America and the Caribbean
  

Who We Are:

Mazars USA LLP is an independent member firm of Mazars Group, an international audit, tax and advisory organization with operations in nearly 100 countries and territories. With roots going back to 1921 in the US, the firm has significant national presence in strategic geographies, providing seamless access to 30,000+ professionals around the world.

Our industry specialists deliver tailored services to a wide range of clients across sectors, including individuals, high-growth emerging companies, privately-owned businesses and large enterprises.

Mazars Partners and professionals work as a single, integrated team, committed to helping our clients and their people succeed by respecting who they are and how they work. We take great pride in the quality of our work and the services we provide, and we are committed to helping build the economic foundations of a fair and prosperous world.

Mazars USA LLP is an equal opportunity/affirmative action employer and maintains a drug-free workplace.

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