Claims Analyst

2 days ago

Bakersfield, California, United States Innovative Integrative Health Full time
About the Role

We are seeking a highly skilled and detail-oriented Claims Analyst to join our team at Innovative Integrative Health. As a Claims Analyst, you will play a critical role in ensuring the accuracy and efficiency of our claims processing system.

Key Responsibilities
  • Review and analyze claims to ensure accuracy and completeness
  • Verify and update information on submitted claims
  • Review contract information and policies to determine eligible charges for reimbursement
  • Ensure completeness and accuracy with claims processing to support our revenue cycle
  • Collaborate with other departments to resolve claims errors and provide solutions
  • Conduct basic contract review to confirm payment rates
  • Request and review monthly inventory trackers from our Third Party Administrator
  • Conduct follow-up activities for claims held until closure
  • Confirm claims association with pre-authorizations from our Interdisciplinary Team and Primary Care Providers
  • Coordinate benefits to ensure claims impact primary and secondary insurance, as appropriate
  • Review and analyze claims loss, expense reserves, and reconcile claims reports with authorization sheets
  • Process new claims and disseminate them to our Third Party Administrator
  • Report claims issues to our Interdisciplinary Team, Primary Care Providers, Vice President of Finance, and other entities, as necessary
  • Assist our Claims Supervisor in identifying exposures to the company and reporting to senior-level management on pending claims and litigation that may impact corporate goals
  • Assist our Claims Supervisor as a liaison between our Third Party Administrator, provider network, insurance companies, and other entities, as needed
  • Check pricing of claims through contracted rates and Medicare/Medicaid fee schedules
Requirements
  • High School Diploma with two (2) years of relevant experience required
  • Bachelor's degree preferred
  • 2+ years of professional experience processing and analyzing claims is strongly preferred
  • Ability to present information in one-on-one and group settings
  • Ability to communicate information in a professional and confident manner
  • Demonstrated ability in critical thinking, self-initiative, and self-direction
  • Understanding of physiology, medical terminology, and disease process is strongly preferred
  • Demonstrated PC skills in Word, Excel, and Microsoft Access
  • Detail-oriented
Core Values
  • Respect at the core of our interactions
  • Honesty and Integrity with every endeavor
  • Patient-Centered care aligned with participant values, beliefs, and preferences
  • Encouragement that motivates and empowers others to be the best they can be
  • Quality Care that is efficient, transformative, and innovative
Salary

$22.50 per hour

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