Job Openings in Sacramento County and Beyond
Medical Claims Analyst (Remote)
Sacramento, CA 95831
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.)