Claims Reporting Analyst

About the role

This role is primarily to support the provider community on claims projects to avoid provider abrasion, review root cause, and make necessary system updates. The role reports to the Senior Director of Claims and will interact with all integral departments.

Responsibilities

• Assist the claims department with projects, including issue resolution in a timely manner.
• Analyze claims based on contracts and fee schedules in the EZ-Cap system to identify potential issues and improve payment accuracy and overall quality.
• Handle all projects timely and accurately based on health plan, CMS, DHCS, and DMHC requirements.
• Analyze data and run reports for quality improvement.
• Prepare documentation for the claims department as needed.
• Communicate effectively with claims management staff, claims production staff, external vendors, and other organizations.
• Interact with the Claims Management team and provide feedback to Imperial’s Executive Team.
• Identify potential project risks and escalate critical issues for appropriate and timely resolution.
• Monitor time commitments and resources for projects.
• Assist with vendor-related activities such as tracking contract provisions, contract guarantees, invoices, and processing data requests.
• Work with external providers on claims issues in a timely and accurate manner and report back to claims leadership and senior leadership.
• Perform other duties as assigned.

Requirements

• High School Diploma or GED (minimum education).
• At least two years of experience performing medical claims or similar analysis.
• Experience as an analyst in a healthcare claims department or managed care environment.
• Knowledge of Medi-Cal Guidelines and billing practices, as well as RBRVS.
• Basic knowledge of CPT/ICD-9 and ICD-10, HCPCS, CPT, and Hospital Revenue coding.
• Knowledge of Medi-Cal, Medicare, and Exchange lines of business as they relate to claims adjudication.
• Proficiency in Microsoft applications.
• Strong attention to detail and confidentiality.
• Punctuality and consistent attendance are critical.
• Ability to work effectively in a team environment.

Job Type: Full-time
Location: Pasadena, CA