Claims Audit Coordinator - Collections

About Cedar Gate Technologies

Cedar Gate Technologies, an IQVIA business, enables payers, providers, employers, and service administrators to excel at value-based care with a unified technology and services platform delivering analytics, care, and payment technology on a single data management foundation. At Cedar Gate, you’ll be part of a collaborative, innovative environment where great ideas thrive. We invest deeply in our people through ongoing training, comprehensive benefits, and a strong culture of teamwork, offering the chance to grow your skills while contributing to high impact initiatives for some of the world's most dynamic companies.

Position Summary

The Claims Collections Representative, Value-Based Care (VBC), plays an important role in resolving complex accounts receivable and outstanding claims associated with value-based care and bundled payment arrangements. This position researches and reconciles accounts, investigates unresolved claims, navigates payer requirements, and works to ensure appropriate and timely reimbursement.

We’re looking for a proactive, analytical professional who communicates effectively, takes ownership of problems, and is comfortable learning and navigating complex reimbursement models and evolving processes. The role collaborates with internal teams, clients, payers, vendors, and external agencies as needed to resolve claims and support organizational collection goals.

Roles & Responsibilities

• Research and resolve complex claims and accounts receivable involving value-based care, bundled payments, and other healthcare reimbursement models.
• Analyze claims, payment variances, payer requirements, and contract terms to identify issues and drive resolution.
• Investigate account discrepancies and complete necessary corrections and adjustments.
• Work with payers, provider offices, clients, patients, and internal teams to resolve claims and reimbursement issues.
• Verify insurance, eligibility, and benefit information and ensure accurate payment posting.
• Prepare and submit appeals with appropriate medical records and supporting documentation.
• Identify reimbursement trends, recurring issues, and opportunities to improve claims resolution and collection processes.
• Support team initiatives, special projects, and other responsibilities as needed.

Job Location

Houston, TX (Galleria Area)

Work Arrangement

Hybrid (3 days in office, 2 remote)   

Experience / Qualifications

• Minimum of 3 years of experience in medical collections, revenue cycle, accounts receivable, or healthcare reimbursement. Cardiology experience preferred.
• Experience researching and resolving claim denials, underpayments, payment discrepancies, and other complex reimbursement issues.
• Working knowledge of managed care contracts, payer policies, medical terminology, and healthcare reimbursement practices. Experience with value-based care or bundled payment arrangements preferred.
• Strong analytical and critical thinking skills with the ability to investigate account issues and interpret complex reimbursement and payment scenarios.
• Strong attention to detail with a demonstrated commitment to accuracy, accountability, and timely follow-through.
• Excellent verbal and written communication skills with the ability to clearly communicate complex claims and reimbursement information to payers, providers, clients, and internal teams.
• Ability to work independently, take initiative, solve problems, and exercise sound judgment with minimal supervision.
• Ability to collaborate effectively with internal and external stakeholders in a team-oriented environment.
• Proficiency with Microsoft Excel, Outlook, and Word, including using Excel to review data and identify trends.
• High school diploma or equivalent required. Associate or bachelor’s degree in a related field preferred.
• Positive, adaptable approach with a willingness to learn new reimbursement models, payer requirements, systems, and processes.

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.

The potential base pay range for this role, when annualized, is $37,400.00 - $93,600.00. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.