Claims Quality Analyst
Location: Los Angeles
Posted on: September 27, 2024
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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: , Los Angeles , Claims Quality Analyst, Healthcare , Los Angeles, California
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here to apply!
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