Job Details

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 escalate 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

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.