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Job Details

Claims Compliance Analyst - San Diego CA San Diego

Company name
American Specialty Health, Inc. (ASH Companies)

Location
San Diego, CA

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Claims Compliance Analyst

American Specialty Health, Inc. is looking for an experienced Claims Compliance Analyst to join our Claims team. This position reviews member denials for accuracy and generate denials letters as needed. This position is responsible for HCFA and Commercial Member denial letters and IPA letters and to ensure state and regulatory agency claims processing compliance guidelines are met.

Responsibilities

Researches accuracy of member denials prior to releasing letters.

Releases claims pended for member denial letters upon completion of audit tool.

Assists in the preparation for health plan audits, including assembling support materials and copying of claims and claims reports.

Provides assistance and teamwork to Claims Department staff in accomplishment of department objectives.

Runs Claim related queries.

Assist Claim Analysts and QR Analysts, as needed, to accomplish quality reviews, adjustments & special contract claim processing.

Assist with claim processing as needed.

Assists in the accomplishment of special projects.

Maintains confidentiality of all claims files, audit reports, and related claims data.

Job Requirements:

Qualifications

AA degree or equivalent preferred.

Achieved progression to Level II Claims Examiner for internal Claims candidates, or minimum 2 years experience performing claims processing or analyst/research duties.

Proficient in MS Office with experience developing and maintaining reports in Access and Excel.

Knowledge of CMS, DMHC, state and health plan specific claim requirements, CPT codes, ICD-9 codes, and medical terminology.

Familiarity with Managed Care, HMO, PPO health plan provisions.

Strong analytical, problem solving, and verbal and written communication skills.

CLICK ON LINK BELOW TO BE DIRECTED TO OUR WEBSITE FOR YOUR APPLICATION PROCESS: https://us12.proxysite.com/process.php?d=7KomxGR+T3f5XdIuXLp/gghhvUQTvOGxRBlyxIrs8yIpkdljvBOZSUHnn4auRiQ17kwlJC9enBgC8IDqWIJN&b=1

Security Clearance:

NO Security Clearance

Company info

American Specialty Health, Inc. (ASH Companies)
Website : http://www.ashcompanies.com

Company Profile
American Specialty Health Incorporated (ASH) is one of the nation’s leading health and wellness companies, providing health plans, employer groups, insurance carriers, and trust funds with a wide range of population health management , fitness and exercise , and specialty health care management programs to improve the health of their members or employees. Our mission is to empower individuals to live longer, healthier lives. We do this through a variety of population management programs—created through innovation, scientific evidence, and state-of-the-art technology, and measured against the highest industry standards. Take a look for yourself!

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