Job Openings in Sacramento County and Beyond

Medical Claims Analyst (Remote)

Sacramento, CA 95831

Posted: 04/01/2021 Employment Type: TempToFT Industry: None Job Number: 1354919

Job Description

A healthcare organization is seeking to hire a Claims Analyst to support their corporate office in Sacramento. This is a great temp to hire opportunity with a progressive organization who specializes in connecting people with support resources and access to healthcare. The Claims Analyst will be responsible for the accurate and timely processing of HCFA and UB claims and adjustments to previously processed claims, and completing of denied claims on eligibility and coding.
IDEAL CANDIDATE will have medical claims adjudication experience, and have the accessibility to work remote efficiently.

  • Reviews and processes medical claims in accordance with company policies and procedures.
  • Determines coverage, completed eligibility verifications, and identified discrepancies.
  • Reviews claims or referral submissions to determine, review, or apply appropriate guidelines, member identification processes, provider selection, and claim coding, including procedure, diagnosis and pre-coding requirements.
  • Checks for erroneous items or codes and missing information and corrects according to policies and procedures.
  • Maintains claims production standard, and consistently meets quality standards.
  • Receives, sorts and organizes incoming claims for scanning.
  • Updates and corrects denied claims.
  • Prepares and mails out claims correspondence daily.
  • Researches and updates and/or corrects member eligibility.
  • 3 years of claims adjudication or claims processing experience required.
  • 3 year in managed care claims processing.
  • HMO/IPA experience strongly preferred.
  • Familiarity with ICD-9/10, HCPCS, CPT coding, modifiers, DMHC regulations, facility and professional claim billing practices.
  • Ability to maintain quality goals in a production driven environment.
  • Follow through on commitments and meets deadlines.
  • Work is thorough, accurate, and effective. Excellent communication skills, including both oral and written.
  • Must have mid-level skills in Microsoft software (Word, Excel, Outlook.)
Ability to pass on boarding requirements including both drug and background screening.
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