We are recruiting for multiple Claims Analysts to support a busy healthcare department at their corporate office in Sacramento. This is a contract (6 months) opportunity with potential for hire based on performance and business needs. Our client is a progressive organization that specializes in connecting people with support resources and access to healthcare. The Claims Analyst will be responsible for the accurate and timely processing of CMS-1500 and CMS-1450 (UB-04) claims forms, adjustments to previously processed claims and completing denied claims due to eligibility and coding. Mon-Fri, onsite (hybrid opportunity after training and probationary period).

The qualified candidate will have at least one year of experience with Medicare claims processing and adjudication. 

Pay: $23/hour 

PRIMARY RESPONSIBILITIES:

• Review and process medical claims in accordance with company policies and procedures. 

• Determine coverage, complete eligibility verifications, and identify discrepancies. 

• Review 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.

• Check for erroneous items or codes, missing information and make corrections according to policies and procedures. 

• Maintain claims production standard and consistently meet quality standards. 

• Receive, sort, and organize incoming claims for scanning.

• Update and correct denied claims. 

• Prepare and mail out daily claims correspondence.

• Research, update and/or correct member eligibility.

SKILLS & QUALIFICATIONS:

• 1 year of Medicare claims processing experience required. 

• 1 years in managed care claims processing and claims adjudication desired.

• High School Diploma required, Associate’s degree preferred.

• Medicare HMO/IPA experience required.

• Familiarity with ICD-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.

• Excellent communication skills, including both oral and written.

• Ability to pass a drug screen and background check.