Job Openings in Sacramento County and Beyond
Sacramento, CA 95831
Pacific Staffing is partnering with a busy healthcare organization in the search to hire a Claims Analyst to support their corporate office in Sacramento. This is a temporary 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.
- 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 claim s correspondence daily.
- Research and updates and/or correct member eligibility.
- 3 years of claims adjudication or claims processing experience.
- 3 years 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.)
- Must have the ability to quickly learn and use new software tools.
- Ability to pass on boarding requirements including both drug and background screening.
Please apply or send your resume to liza@pacificstaffing.Com - Thank you!