Claims Recovery Analyst

About the role

This is a remote position. Must reside in California in our service area.

Responsibilities

• Research claims to validate overpayments.
• Verifies accuracy and receipt of information.
• Identifies claims error patterns and trends resulting in overpayments.
• Initiates recovery of overpayments in writing, clearly outlining the reason for the refund request.
• Makes sure recovery requests are monitored and followed up on.
• Processes recoveries based on established procedures.
• Creates and submits detailed reports, including outcome reports.

Requirements

• In-depth knowledge of regulations governing Medi-Cal as they relate to claims processing.
• In-depth knowledge of procedure coding and medical terminology, and their application in claims.
• In-depth knowledge of industry standard payment practices and HPSJ systems as they relate to claims processing.
• Basic knowledge of data analysis and communication/reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.
• Produces work that is accurate and complete, and appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with ability to express self clearly and professionally, with appropriate grammar and spelling, and document according to standards.
• Ability to work independently and as part of a team.
• Strong organizational skills, with the ability to prioritize and complete a wide variety of tasks.
• Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
• Time management and organizational skills.
• Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Basic arithmetic skills.
• Basic skills in Windows, Excel, Word, and Outlook.
• Ability to handle confidential information with appropriate discretion.
• Ability to speak and be understood in English.

Qualifications

• High school diploma or general education degree.
• At least one year experience in claims auditing.
• Prioritize and complete a wide variety of tasks.
• Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
• Time management and organizational skills.
• Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Basic arithmetic skills.
• Basic skills in Windows, Excel, Word, and Outlook.
• Ability to handle confidential information with appropriate discretion.
• Ability to speak and be understood in English.

Skills

• Knowledge of regulations governing Medi-Cal as they relate to claims processing.
• Knowledge of procedure coding and medical terminology, and their application in claims.
• Knowledge of industry standard payment practices and HPSJ systems as they relate to claims processing.
• Basic knowledge of data analysis and communication/reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.
• Produces work that is accurate and complete, and appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills, with ability to express self clearly and professionally, with appropriate grammar and spelling, and document according to standards.
• Ability to work independently and as part of a team.
• Strong organizational skills, with the ability to prioritize and complete a wide variety of tasks.
• Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
• Time management and organizational skills.
• Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
• Basic arithmetic skills.
• Basic skills in Windows, Excel, Word, and Outlook.
• Ability to handle confidential information with appropriate discretion.
• Ability to speak and be understood in English.

Benefits

HPSJ Perks: Robust and affordable medical coverage including HMO and PPO plan options Employee Wellness Program promoting physical, mental, and financial well-being Dental and vision plan with multiple provider choices Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays) CalPERS retirement pension program, automatic employer-paid retirements contributions, plus a voluntary defined contribution plan Two flexible spending accounts (FSAs)for healthcare and dependent care expenses Employer-Paid Term Life and AD&D Insurance Employer-Paid Disability Insurance Employer-Paid Assistance Program (EAP) Health Advocacy to help you navigate medical care and benefits Voluntary supplemental benefits including medical, legal, identity theft protection Online discount mall Tuition reimbursement Remote work contingent on business needs and company guidelines A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do

Pay

Commensurate with experience.

Schedule

Remote work contingent on business needs and company guidelines.