Temporary Fixed Term Claims Research Analyst - 4 months

PriMed Management Consulting • San Ramon, CA

4d

About The Position

This position is responsible for sorting and researching incoming mail to identify appeals, disputes, and correspondences. The analyst will also research and process Epic CRM tickets accurately and timely, ensuring compliance with health plan contracts and Hill Physicians’ policies.

Requirements

• One year internal/external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO), or health plan.
• Working knowledge of CPT codes, ICD-10 codes, Revenue Codes, and HCPC codes.
• Must type at least 40 WPM on a personal computer/keyboard.
• Strong research, judgment, decision-making and problem-solving skills.
• Ability to work independently or as a team.
• Strong written- and verbal-communication skills including maintaining open lines of communication within all departments of the organization.
• Ability to work in a fast-paced environment.
• Ability to focus on repetitive claims sorting detailed information.

Nice To Haves

• Medical terminology preferred

Responsibilities

• Screen and research claim appeals and disputes to ensure they contain pertinent and correct information for review and adjustments.
• Accurate claims adjudication using the claims processing system. This includes research on previously processed claims when needed.
• Utilize CRM to document incoming appeals and disputes and generate acknowledgement letters.
• Complete assigned projects to meet department and company goals.
• Identify billing patterns, processing errors, and/or system issues that inhibit the final adjudication of claims.
• Maintain 98% accuracy rate.
• Maintain 100% productivity goal.

What This Job Offers

• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 251-500 employees