SantaAnaRecruiter Since 2001
the smart solution for Santa Ana jobs

Claims Analyst

Company: Kaiser Permanente
Location: Santa Ana
Posted on: November 18, 2022

Job Description:

This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data-entered information and by analyzing claims-related information and invoice adjudication/payment for compliance with contract terms and department/regional policy and procedures. The Claims Analyst must be thoroughly familiar with outside medical systems and claims processing/adjudication processes. The position requires research, problem resolution and specialized knowledge in the areas of Medicare, Multiplan, Workers' Compensation, Coordination of Benefits and Third Party liability. The Claims Analyst may provide education and feedback to staff involved in the related processes and may assist with recovery of funds and timely response to appeals.Essential Functions:- Analyzes referrals and claims information for accuracy according to established guidelines and provides education/feedback and reports as applicable.- Assists Claims Auditor with tracing sources of inaccuracies; reports and proposes remedial action to appropriate manager.- Prepares detailed analysis of claims activity and submits reports/findings as requested.- Carries out and maintains records of special processing payment adjustments/check requested.- Works with Finance Department and others as resource regarding all aspects of Outside Medical Claims; researches and provides reports as requested.- Reviews processing of outside medical payments on a continuous basis.- Ensures safeguarding of assets through the verification of documentation, approvals and accurate coding of provider service and accounting data.- Monitors and coordinates special transactions such as check adjustments and credits.- Performs analysis of data entered for outside medical payments for the purpose of performance feedback.- Formats and prepares statistical reports and works close with CAD and local Finance Department to assist with budget monitoring and to assist with financial analysis activities.- Reviews and recommends accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding.- Performs special comprehensive reports as indicated or requested by management.Basic Qualifications:Experience- Minimum two (2) years of claims analysis and medical billing experience.Education- High School Diploma or General Education Development (GED) required.License, Certification, Registration- N/A. Additional Requirements:- Knowledge of CPT, ICD, RBRVS, and other applicable references.- Demonstrated knowledge of both mainframe and personal computer programs.- Excellent mathematical, written and verbal skills and demonstrated medical terminology competence.- A proven ability to think and act independently and professionally.- Able to understand, develop and implement procedures.- Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications:- Bachelor's degree in accounting, audit, finance or management is preferred.COMPANY: KAISERTITLE: Claims AnalystLOCATION: Santa Ana, CaliforniaREQNUMBER: 1108735External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Keywords: Kaiser Permanente, Santa Ana , Claims Analyst, Professions , Santa Ana, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Santa Ana RSS job feeds