Claims Reimbursement Analyst

We are looking for a Claims Reimbursement Analyst for a Denver-based health plan client. This is a 12-month contract with potential to convert to full-time. The role focuses on complex Medicare reimbursement policy and claims adjudication not basic fee-for-service review. Ideal candidates have hands-on experience with Medicare reimbursement methodologies, can manually price claims without a tool, and can clearly explain reimbursement concepts to non-technical stakeholders.

Candidates must be local to Denver or surrounding areas, or willing to relocate after the contract period. The role converts to hybrid with 2-3 days on-site per week. U.S. citizens and permanent residents only.

Candidate Pre-screening Questions:

1. Walk me through how you would manually price a complex Medicare claim without a tool.
2. Which of the following have you worked with hands-on: DRG, OPPS, APC, site-neutral, No Surprises Act, EAPG, MAC pricing, per diems, LTAC?
3. Have you ever interpreted CMS guidance or transmittals independently to determine how a claim should pay?

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