Analyst I

2 weeks ago

Rancho Cucamonga California, United States Inland Empire Health Plan Full time
Overview:
What you can expect 

 

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

 

Under the direction of the Supervisor of Provider Data Configuration, the Analyst is responsible for managing the front-end maintenance of Provider records within the Business System. The primary functions of this position include but are not limited to, accurate interpretation of contractual and claim related provider information, systematic review, and setup of provider data to be in line with business requirements, and in-depth root cause analysis for provider configuration related issues that arise from claims and integrated systems errors.

 

The Analyst is independent and acts as a subject matter expert for the business areas and other team members, by helping to drive decisions related to provider configuration. The incumbent will develop and maintain comprehensive documentation of business and technical specifications based on best practice guidelines and regulatory operational requirements. The Analyst will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary

Additional Benefits:
Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

 

CalPERS retirement

457(b) option with a contribution match

Generous paid time off- vacation, holidays, sick

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Paid life insurance for employees with additional options

Short-term, and long-term disability options

Pet care insurance

Flexible Spending Account – Health Care/Childcare

Wellness programs that promote a healthy work-life balance

Career advancement opportunities and professional development

Competitive salary with annual merit increase

Team bonus opportunities

Qualifications:
 

Education & Experience

 

Two (2) years of experience in Business Systems Configuration or Managed Care Operations or Contracting in Healthcare experience required

Bachelor’s Degree in Business Administration, Health Care Administration, Computer Information Systems (CIS), Management Information Systems (MIS), or other related field from an accredited institution required

In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: two (2) years of Health Care or Managed Care Operations experience is required and two (2) years of claims auditing or Provider Contracting required

 

 

Key Qualifications

 

Knowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines preferred. Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred

Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines a plus

Familiar with basic medical claims processing

Experience in major managed care system migration/implementation preferred.

Basic knowledge of general managed care operations required; delegated plan model preferred

Basic knowledge of relational database structure

 

 

 

 

 

 

 

 

 

 

 

Start your journey towards a thriving future with IEHP and apply TODAY

Pay Range:
USD $34.41 - USD $44.73 /Hr.

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