RRT Analyst - Product

POSITION SUMMARY The RRT (Rapid Response Team) Analyst is responsible for reviewing, analyzing, and adjusting medical claims to ensure accurate processing in accordance with regulatory requirements, payer policies, and internal guidelines. This role involves investigating claim discrepancies, validating benefit coverage, correcting errors, and communicating with providers, members, and internal teams to resolve issues promptly and efficiently. ESSENTIAL FUNCTIONS Review medical claims flagged for adjustment, correction, or reconsideration. Verify claim accuracy, including coding (ICD 10, CPT, HCPCS), billed charges, and reimbursement methodologies. Research missing or conflicting information and resolve discrepancies in accordance with organizational and payer rules. Process claims adjustments, denials, and reopens while maintaining high accuracy standards. Analyze medical records, billing documents, and provider submissions to confirm the validity of claims. Identify patterns or recurring errors and escalates them for process improvement. Ensure claims align with contractual obligations, fee schedules, and prior authorization requirements. Ensure adherence to federal and state regulations, including HIPAA. Maintain up to date knowledge of benefit plans, reimbursement policies, and regulatory guidelines. Meet or exceed quality and productivity performance metrics. Communicate with providers, members, and internal departments (Customer Service, Medical Management, Provider Relations) to clarify claim issues. Document claim findings, rationales, and adjustments in the claims processing system. Support internal teams with claim related questions or trends. Other duties as assigned. EDUCATION High school diploma or equivalent (Associate degree in Healthcare Administration or related field preferred) or equivalent work experience required. EXPERIENCE AND SKILLS At least 1 year of experience in medical claims processing, claims adjustments, or related healthcare operations required. Working knowledge of medical terminology, coding systems (ICD 10, CPT, HCPCS), and industry standard reimbursement method required. Proficiency in claims processing software and Microsoft Office applications required. Strong analytical, problem solving, and organizational skills required. Ability to work accurately under deadlines and manage high volume workloads required. Knowledge of UB 04 and CMS 1500 claim forms required. Familiarity with utilization management workflows or medical management operations preferred. POSITION COMPETENCIES Job Knowledge Time Management Accountability Communication Initiative Customer Focus PHYSICAL DEMANDS This is standard desk role requiring extended periods of sitting and computer work. WORK ENVIRONMENT Remote Remote work requires an internet connection via cable broadband or fiber optic service with speeds of at least 100"¯Mbps download/25"¯Mbps upload to ensure reliable connectivity and productivity. BENEFITS Medical, Dental, Vision, Life and Disability Insurance Generous Paid Time Off Tuition Reimbursement Employee Assistance Program (EAP) Technology Stipend #J-18808-Ljbffr

Created: 2026-04-20