Claims Operations Analyst
: Job Details :

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day.

Job Overview

The Claims Operations Analyst is responsible for the compilation and scrubbing of claims data to analyze, track, and trend various aspects of the adjudicated claims. This includes but is not limited to, TAT compliance, Production, Error Rate, mid-month reports for forecasting, Health Plan monthly reporting including ODAG and Part C, Health Plan Universes for Audits, reports to identify potential recovery, as well as reports requested by Claims Management. The Claims Operations Analyst identifies root causes of claims payment errors reports to Management and collaborates with other departments and/or providers in a successful resolution of claims-related issues.

Minimum Requirements

• Minimum of 3 years of claims experience in a managed care environment is preferred.
• Must understand how to read and interpret DOFRs and Contracts.
• Must have an understanding of how to read a CMS-1500 and UB-04 form.
• HS Diploma or GED required.
• Must be knowledgeable of Medi-Cal, Commercial, and Medicare rules and regulations.
• Knowledge of medical terminology.
• Must have strong organizational and mathematical skills.
• Must have SQL coding and programming experience.

Compensation

$68,640.00 - $85,800.00 annually

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.