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2 results for Insurance Referral Coordinator in Raleigh, NC
- Raleigh, NC
- onsite
- Temporary to Hire
- 26.6 - 30.8 USD / Hourly
- We are looking for a detail-oriented Medical Claims Analyst to join a team supporting Medicaid audit and claims review activities in Raleigh, North Carolina. This contract opportunity is ideal for someone who can evaluate provider billing practices, examine payment accuracy, and contribute to compliance-focused reviews with growing independence. The role offers the chance to apply analytical judgment, strengthen audit documentation, and help improve the integrity of Medicaid-related claims operations.<br><br>Responsibilities:<br>• Review provider billing records and medical claim activity to identify discrepancies, validate payments, and assess adherence to Medicaid guidelines<br>• Carry out structured audit procedures for claims, denials, rejected claims, and billing documentation to support program integrity efforts<br>• Interpret applicable Medicaid requirements and federal regulatory standards when analyzing audit results and determining potential issues<br>• Develop clear working papers, summaries, and preliminary findings that accurately document testing performed and conclusions reached<br>• Partner with internal stakeholders to clarify claim exceptions, address audit questions, and support corrective action recommendations<br>• Analyze medical billing and Medicaid claim data to detect patterns, trends, and areas requiring additional review<br>• Contribute to compliance examinations involving provider assessments, payment verification, and operational claim review activities
- 2026-04-23T00:00:00Z
- Raleigh, NC
- onsite
- Temporary to Hire
- 27.7115 - 32.087 USD / Hourly
- We are looking for a Medical Claims Analyst to join our team in Raleigh, North Carolina on a Contract to permanent basis. This position is ideal for a detail-oriented individual who can evaluate Medicaid-related claims activity, support audit initiatives, and help maintain compliance with healthcare payment standards. The role offers the opportunity to work independently on analytical reviews while partnering with internal teams to strengthen accuracy, documentation, and regulatory alignment.<br><br>Responsibilities:<br>• Review provider records and claims activity to assess payment accuracy and identify discrepancies requiring follow-up.<br>• Perform audit procedures tied to Medicaid claims, billing practices, denials, and rejected claims to support program integrity efforts.<br>• Interpret Medicaid rules and applicable federal guidance when evaluating findings and determining compliance outcomes.<br>• Prepare organized workpapers, summaries, and preliminary reports that clearly document testing results and supporting analysis.<br>• Investigate claim issues and collaborate with stakeholders to address exceptions, recommend corrective actions, and support resolution plans.<br>• Analyze medical billing and reimbursement data to detect trends, payment concerns, and areas of potential financial risk.<br>• Support compliance reviews involving provider activity, claim adjudication, and payment validation across assigned cases.
- 2026-04-23T00:00:00Z