Current jobs related to Healthcare Claims Analyst - Industry, California - Innovative Management Systems Incorporated

Position Overview:
We are seeking a meticulous professional to thoroughly evaluate, investigate, and interpret healthcare claims to ascertain and compute the appropriate benefits in accordance with predefined standards and provider agreements.

Qualifications:
Prior experience in the adjudication of Commercial, Medicare Advantage, and Medi-Cal claims is highly advantageous. Familiarity with the Healthcare Service sector, Independent Physician Associations (IPAs), or a background in Managed Care/Service Organizations (MSOs) or Health Plans will enhance your candidacy.

Employment Type: Full-Time
Benefits:
Eligible for Medical, Dental, Vision, Paid Time Off, and additional perks.
Work Schedule: Monday - Friday.

Key Responsibilities:
- Assessing authorizations and aligning them with claims.
- Addressing and resolving claims inquiries from both internal and external parties.
- Processing claims within the appropriate financial categories.
- Identifying instances of dual coverage and potential third-party liability claims.
- Comprehending and interpreting health plan financial responsibility divisions and contract language.
- Assisting the Claims Department and collaborating with other Examiners to troubleshoot claims-related issues.
- Documenting resolutions of claims to facilitate payment and decision-making.

About Us:
Innovative Management Systems is dedicated to delivering management services that prioritize regulatory compliance, customer satisfaction, provider engagement, and measurable outcomes within the healthcare industry. Our advanced data analytics platform is designed to enhance medical spending efficiency, HEDIS, and STAR metrics through collaborative education, reporting, and workflow management. Join our team to contribute to the enhancement of care quality, reduction of administrative burdens, and the pursuit of excellence through innovative thinking and informed risk-taking. We value diverse perspectives and encourage self-motivated individuals with fresh ideas to join us in shaping a better future.

Requirements:
- High School Diploma or equivalent experience in managed care/services, health plans, or IPAs.
- At least 1 year of relevant claims processing experience in managed care/services, health plans, or IPAs (preferred).
- Strong comprehension of financial responsibility divisions for risk assessment.
- Practical knowledge of applicable business practices and regulations.
- Proficient understanding of contract language and claims processing software.
- Valid Driver's License or reliable commuting capability.
- Compensation: $20-24 Hourly Wage.