Claims Validation Analyst

Location: Los Angeles
Posted on: November 11, 2024

Job Description:

If you are looking to expand within the Healthcare Industry and have experience in the following please apply!!!

5+ years claims examiner experience with experience working with complex and high dollar claims. Experience working with PDR's. Must have a strong background in analyzing healthcare data and identifying both problem areas and opportunities for improvement. Experience working with configuration departments, PNO department, UM and IT in researching issues, identifying root causes, formulating a resolution plan and conducting user acceptance testing. A sound understanding of health care code sets including CPT, HCPCS, ICD-9 and revenue codes required. Some experience with DRG pricing is desirable. Familiar with medical terminology. Familiarity in working with and interpreting Provider and facility contracts and LOA's and MOU's. Very detail oriented and have the ability to draw conclusions from data analysis and to formulate corrective action plans when necessary. Have advanced skills in using Microsoft Word and Excel. Excellent written and verbal communication skills with ability to work effectively with peers, subordinates and managers. Able to communicate effectively with other departments throughout the company and have the ability to review issues and error reports and prioritize according to impact on the claims department and company. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Rialto , Claims Validation Analyst, Administration, Clerical , Los Angeles, California