Hybrid Lead, Claims Operations

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 37,000 - 44,000; Full time

Job summary

Astrana Health, Inc. is seeking a highly motivated Lead - Claims Operations in Monterey Park, CA. This hybrid role combines in-office collaboration with remote work on a weekly basis.

You will oversee Claims Quality, Appeals and Recovery teams, drive training, and ensure compliance with CMS regulations and internal policies. Collaboration with Accounting and Physician Services is essential.

Qualifications

• Bachelor's degree in a relevant field or equivalent experience.
• 5+ years of claims experience in Medical Groups/IPA/MSO/Health Plan.
• Advanced knowledge of ICD-10, CPT, and HCPCS coding conventions.
• Thorough knowledge of claim processing procedures, CMS regulations and compliance.
• Experience with claims processing systems configuration and architecture.

Responsibilities

• Monitor and review Claims Quality, Appeals and Recovery staff performance.
• Provide performance feedback and identify development opportunities.
• Identify claim error trends and implement controls to minimize incorrect adjudication.
• Coordinate potential recovery efforts with Accounting and physician education with relevant teams.
• Ensure all departments support claims quality goals.
• Communicate recovery audit findings to improve adjudication and controls.

Skills

ICD-10 CPT HCPCS coding

Claims processing

Quality auditing

EZ Cap knowledge

Education

Bachelor's degree in a relevant field

Tools

Claims processing systems

Job description

Astrana Health, Inc. is seeking a highly motivated Lead - Claims Operations in Monterey Park, CA. This hybrid role combines in-office collaboration with remote work on a weekly basis.

You will oversee Claims Quality, Appeals and Recovery teams, drive training, and ensure compliance with CMS regulations and internal policies. Collaboration with Accounting and Physician Services is essential.