CHEManager International · 2 hours ago
Claims Research Analyst - 25-208
San Ramon, CA
Full-time
Onsite
Entry Level
$23/hr - $26/hr
1+ years expHill Physicians Medical Group is shaping the healthcare of the future through actively managed care. The Claims Research Analyst will primarily research incoming claims, ensuring accurate processing and adherence to policies while maintaining productivity and accuracy goals.
Newspapers
Responsibilities
Screen and research all claims to ensure the following:
Claim contains pertinent and correct information for processing PDRs and adjustments
Accurate final claims adjudication by using on-line computer claims payment system. This includes research on previously processed claims when needed
Maintain 98% accuracy rate
Maintain 100% productivity goal
Utilize Epic to document PDRs/adjustments as needed
Develop a CRM and generate letters as appropriate
Complete special projects as assigned to meet department and company goals
Identify billing patterns, processing errors, and/or system issues that inhibit the final adjudication of claims
Qualification
Required
One year internal/external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO) or HP
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
High School Diploma/GED required
Preferred
Medical terminology preferred
Company
CHEManager International
Wiley’s leading media brand providing first-hand information on the global chemical, life science and process industries
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase