A busy healthcare organization is looking to hire a Claims Analyst to support their corporate office in Sacramento. This is a contract 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 denied claims due to eligibility and coding. Hybrid schedule after training and probationary period. Pay: $20-$22/hour DOE.  

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

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.

QUALIFICATIONS:

• 1 year of claims adjudication or claims processing experience required. 

• 1 years in managed care claims processing desired.

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

• 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.

• Excellent communication skills, including both oral and written.