Claims Recovery Analyst

SAN JOAQUIN COUNTY HEALTH COMMISSION•French Camp, CA

16h•$57,000 - $79,000•Hybrid

About The Position

Join our team as our new Claims Recovery Analyst with Health Plan of San Joaquin! Under general supervision, responsible for researching, resolving, pursuing, and processing refund requests, and/or identifying payment error patterns and trends resulting in overpayment of claims. Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships.

Requirements

In-depth knowledge of regulations governing Medi-Cal as they relate to claims processing.
In-depth knowledge of procedure coding and medical terminology, and their application in claims.
In-depth knowledge of general medical policy benefits and exclusions.
In-depth knowledge of industry standard payment practices and HPSJ systems as they relate to claims processing.
Basic knowledge of data analysis and communication/reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.
Produces work that is accurate and complete, and appropriate amount of work.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Strong oral and written communication skills, with ability to express self clearly and professionally, with appropriate grammar and spelling, and document according to standards.
Ability to work independently and as part of a team.
Strong organizational skills, with the ability to prioritize and complete a wide variety of tasks.
Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
Basic arithmetic skills.
Basic skills in Windows, Excel, Word, and Outlook.
Ability to handle confidential information with appropriate discretion.
Ability to speak and be understood in English.
High school diploma or general education degree
At least one year as an Analyst III or equivalent

Nice To Haves

Associate degree
Experience in healthcare claims auditing or analysis.

Responsibilities

Research claims to validate overpayments.
Verifies accuracy and receipt of information.
Identifies claims error patterns and trends resulting in overpayments.
Initiates recovery of overpayments in writing, clearly outlining the reason for the refund request.
Monitors recovery requests; follows up and escalates as required.
Processes recoveries based on established procedures.
Posts and applies refunds to appropriate claims.
Creates and submits detailed reports, including outcome reports.

Benefits

Robust and affordable medical coverage including HMO and PPO plan options
Employee Wellness Program promoting physical, mental, and financial well-being
Dental and vision plan with multiple provider choices
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, plus a voluntary defined contribution plan
Two flexible spending accounts (FSAs)for healthcare and dependent care expenses
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Assistance Program (EAP)
Health Advocacy to help you navigate medical care and benefits
Voluntary supplemental benefits including medical, legal, identity theft protection
Online discount mall
Tuition reimbursement