What are the responsibilities and job description for the Claims Recovery Analyst position at SAN JOAQUIN COUNTY HEALTH COMMISSION?

Job Description

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

We are currently hiring a Claims Recovery Analyst to join our team!

Must reside in California - remote position.

Join our team as our new Claims Recovery Analyst with Health Plan of San Joaquin!

What You Will Be Doing :

Under general supervision, responsible for researching, resolving, pursuing, and processing refund requests, and / or identifying payment error patterns and trends resulting in overpayment of claims.

Our Vision :

Continuously improve the health of our community.

Our Mission :

We provide healthcare value and advance wellness through community partnerships.

Essential Functions :

Research claims to validate overpayments.
Verifies accuracy and receipt of information.
Identifies claims error patterns and trends resulting in overpayments.
Initiates recovery of overpayments in writing, clearly outlining the reason for the refund request.
Monitors recovery requests; follows up and escalates as required.
Processes recoveries based on established procedures.
Posts and applies refunds to appropriate claims.
Creates and submits detailed reports, including outcome reports.

What You Bring :

Knowledge, Skills, Abilities and Competencies

Required :

In-depth knowledge of regulations governing Medi-Cal as they relate to claims processing.

In-depth knowledge of procedure coding and medical terminology, and their application in claims.

In-depth knowledge of general medical policy benefits and exclusions.

In-depth knowledge of industry standard payment practices and HPSJ systems as they relate to claims processing.

Basic knowledge of data analysis and communication / reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.

Produces work that is accurate and complete, and appropriate amount of work. Actively learns through experimentation when tackling new problems, using both successes and failures to learn.

Rebounds from setbacks and adversity when facing difficult situations.

Knows the most effective and efficient process to get things done, with a focus on continuous improvement.

Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.

Strong oral and written communication skills, with ability to express self clearly and professionally, with appropriate grammar and spelling, and document according to standards.

Ability to work independently and as part of a team.

Strong organizational skills, with the ability to prioritize and complete a wide variety of tasks.

Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.

Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his / her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.

Basic arithmetic skills. Basic skills in Windows, Excel, Word, and Outlook.

Ability to handle confidential information with appropriate discretion.

Ability to speak and be understood in English.

What You Have :

Education and Experience

Required

High school diploma or general education degree

At least one year as an Analyst III or equivalent

Preferred

Associate degree Experience in healthcare claims auditing or analysis.

Licenses, Certifications

None required.

What You Will Get : HPSJ Perks :

Competitive salary

Robust and affordable health / dental / vision with choices in providers

Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)

CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan

Two flexible spending accounts (FSAs)

Employer-Paid Term Life and AD&D Insurance

Employer-Paid Disability Insurance

Employer-Paid Life Assistance Program

Health Advocacy

Supplemental medical, legal, identity theft protection

Access to exclusive discount mall

Education and training reimbursement in addition to employer-paid elective learning courses.

A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.

A shorter commute – if you’re commuting from the Central Valley to the Bay Area.

Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.

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