Claims Reporting Analyst

Evolving Solution Services; Pasadena (CA); On-site; USD 70,000 - 80,000; Full time

Job summary

Evolving Solution Services is seeking a Claims Reporting Analyst to support provider communities on claims projects and drive payment accuracy. You will analyze contracts, fee schedules, and data to ensure quality and compliance, reporting to senior leadership and collaborating with external partners.

This full-time role requires knowledge of Medi-Cal, Medicare, and exchange lines, along with strong attention to detail and timely project delivery. Prior healthcare claims experience is preferred.

Qualifications

• Knowledge of Medi-Cal, Medicare, and Exchange lines of business as they relate to claims adjudication.
• Attention to detail and confidentiality
• Punctuality and Attendance are critical
• Knowledge of Microsoft applications

Responsibilities

• Assist claims department with projects and resolve issues timely.
• Analyze claims based on contracts and fee schedules to improve payment accuracy.
• Handle projects timely based on health plan, CMS, and DHCS requirements.
• Analyze data and run reports for quality improvement.
• Prepare documentation for the claims department as needed.
• Communicate with claims management, staff, vendors, and other organizations.

Skills

Medi-Cal/Medicare knowledge

Attention to detail

Punctuality

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Claims Reporting Analyst

2 days ago Requisition ID: 1091

Salary Range: $70,000.00 To $80,000.00 Annually

JOB DESCRIPTION

SUMMARY

This role is primarily to support the provider community on claims projects to avoid provier abrasion, review root cause and make necessary system updates, This role reports up to the Senior Director of Claims and will interact with all integral Departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Essential duties and responsibilities include but are not limited to:

• Assisting claims department with projects including any issues and working with claims department to resolve issues timely.
• Analyze claims based on the contracts, Fee schedule in EZ-Cap system to identify any potential issues and improve the payment accuracy and overall quality.
• Handle all projects timely and accurately based on health plan, CMS, DHCS, and DMHC, requirements.
• Analyze the data and run reports for quality improvement.
• Prepares documentation for the claims department as needed.
• Communicates effectively with the claim’s management staff and all claims production staff, as well as with external vendors, and other organizations.
• Interacts with Claims Management team and provides feedback as well as Imperial’s Executive Team
• Identifies potential project risks and escalates critical issues for appropriate/timely resolution as needed.
• Monitors time commitments and resources for projects.
• Assists with vendor-related activities such as tracking contract provisions, contract guarantees, invoices, and processing data requests.
• Works with external providers on claims issues timely and accurately and reports back claims leadership and senior leadership.
• Performs other duties as assigned.

QUALIFICATIONS

Job Title: Claims Reporting Analyst Job Code: To be completed by H.R.

Job Reports to (Title): Senior Manager of Claims Effective Date: 08/01/2020

• Knowledge of Medic-Cal, Medicare, and Exchange lines of business as they relate to claims adjudication.
• Attention to detail and confidentiality
• Punctuality and Attendance are critical
• Knowledge of Microsoft applications

Job Type: Full-time

Minimum Education: High School Diploma or GED

License & Certification Requirement: None

Experience: At least two years performing medical claims or similar analysis. Experience as an analyst in a healthcare claims department or managed care environment. Knowledge of Medi-Cal Guidelines and billing practices and RBRVS. Basic knowledge of CPT/ICD 9 and 10, and HCPCS, CPT and Hospital Revenue coding.