TEMP - Data Warehouse Reporting Analyst Sr - Equiliem

4 weeks ago

Orange, United States Equiliem Full time
Client Summary - Single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health.

Duties & Responsibilities:
  • Responds and researches issues on provider questions regarding claims payments, denials, resolves claim issues, contractual and/or *** Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
  • Follows up with providers as needed.
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets.
  • Routes escalated calls to the appropriate departments and/or management.
Minimum Qualifications:
  • High School diploma or equivalent required.
  • 2 years of experience in claims resolution required.
  • 1 year of call center experience with high call volumes or customer service experience required.
  • 1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:
  • Required Licensure / Certifications
Knowledge & Abilities:
  • Develop rapport and establish and maintain effective working relationships with *** Health's leadership and staff and external contacts at all levels and with diverse backgrounds
  • Work independently and exercise sound judgment.
  • Communicate clearly and concisely, both orally and in writing.
  • Work a flexible schedule; available to participate in evening and weekend events
  • Organize, be analytical, problem-solve and possess project management skills
  • Work in a fast-paced environment and in an efficient manner.
  • Manage multiple projects and identify opportunities for internal and external collaboration.
  • Motivate and lead multi-program teams and external committees/coalitions.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment
Physical Requirements (With or Without Accommodations):
  • Ability to visually read information from computer screens, forms and other printed materials and information.
  • Ability to speak (enunciate) clearly in conversation and general communication.
  • Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
  • Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting
  • Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Schedule Notes:
  • Work hours will fall between 7:00 AM and 8:00 PM.
  • Details and specifics will be discussed during the interview and confirmed at time of offer.
Equiliem Healthcare specializes in staffing clinical, non-clinical, and allied personnel. We excel in all levels, disciplines, and specialties within the healthcare spectrum. Our projects range from short to long term local and travel assignments. Equiliem has been recognized as a certified small business enterprise. In addition, we are proud that we have earned the prestigious Joint Commission accreditation for staffing firms and have been awarded Best in Staffing 4 years running by our employees and client partners.

Benefits offered to our workers include the following:
  • Medical Insurance
  • Vision & Dental insurance
  • Life Insurance
  • 401K
  • Commuter Benefits
  • Employee Discounts & Rewards
  • Payroll Payment Options

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