Claims Quality Analyst

Location: Los Angeles
Posted on: November 14, 2024

Job Description:

If you are looking for an opportunity with an established company and the room for career advancement within the Healthcare setting and you have experience in the follow please apply!!!

Demonstrated depth of knowledge and experience in processing Health Plan claims of a complex nature. Solid understanding of standard claims processing systems and claims data analysis. Extensive experience in monitoring and evaluating the accuracy and efficiencies of processed claims. Advanced working knowledge of claims coding and medical terminology. A deep knowledge of claims code sets including but not limited to ICD9, HCPCS, DRG, APC and other inpatient and outpatient coding systems. An advanced knowledge of contractual pricing mechanisms for inpatient, outpatient, LTC and ancillary services. Experienced in working with enrollment data and be proficient in working with retroactive eligibility changes. Have a deep understanding of the application of Division of Financial Responsibility (DoFR) to claims processing. Extensive experience working with COB and TPL claims in a managed care setting. Highly experienced in interpreting complex contractual terms with Providers, Facilities, Plan Partners, delegated groups and related contractual scenarios. Ability to create simple queries from claims data and to provide in depth analysis of claims data sets. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Rancho Santa Margarita , Claims Quality Analyst, Healthcare , Los Angeles, California