Claims Analyst Job

CLAIMS ANALYST needed for a CONTRACT opportunity with Yoh's client located in San Francisco, CA.

THE BIG PICTURE - TOP SKILLS YOU SHOULD POSSESS:

- Medical Claims Processing Experience
- Thorough knowledge of CPT and ICD-9 Codes

WHAT YOU'LL BE DOING:

- Will be responsible for acknowledging and understanding Plan Documents to determine benefits to accurately process claims to final adjudication and resolution
- Interprets medical policy as it relates to claim payment established by client
- Monitors and reviews pended claims in order to stay within compliance guidelines and meet established hourly, weekly and monthly quality and production standards
- Process all types of medical claims with a thorough understanding of client's claims adjudication policies and procedures (physician, hospital, vendor and ancillary providers) accurately
- Reviews, interprets and applies the correct Medical Service Referrals/Authorizations
- Utilizes appropriate reference materials to research information, to process claims accurately

WHAT YOU NEED TO BRING TO THE TABLE:

- High School Graduate/Some College preferred
- Three (3) years prior claims processing experience in a Hospital, IPA or HMO related setting with extensive focus on Medicare payment policies and methodology (eg DRG)
- Knowledge of ICD-9 Diagnostic Codes, CPT Procedure Coding, HCPC Codes using IDX System experience required
- Thorough knowledge of medical terminology, enrollment and membership activities, and claims processing procedures/systems
- Certified Medical Reimbursement Specialist (CMRS) preferred
- Strong oral and written communication skills
- Ability to work independently, organize and prioritize work

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Annie Gill

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