Temporary Fixed Term Claims Research Analyst - 4 months

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Responsible for sorting and researching incoming mail to identify appeals, disputes, and correspondences. Also responsible for researching and processing Epic CRM tickets accurately and timely in accordance with health plan contracts and Hill Physicians’ policies.

Job Responsibilities:

• Screen and research claim appeals and disputes to ensure they contain pertinent and correct information for review and adjustments.
• Accurate claims adjudication using the claims processing system.  This includes research on previously processed claims when needed.
• Utilize CRM to document incoming appeals and disputes and generate acknowledgement letters.
• Complete assigned projects to meet department and company goals.
• Identify billing patterns, processing errors, and/or system issues that inhibit the final adjudication of claims.
• Maintain 98% accuracy rate.
• Maintain 100% productivity goal.

Required Experience:

• One year internal/external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO), or health plan.
• Working knowledge of CPT codes, ICD-10 codes, Revenue Codes, and HCPC codes
• Medical terminology preferred.
• Must type at least 40 WPM on a personal computer/keyboard.
• Strong research, judgment, decision-making and problem-solving skills.
• Ability to work independently or as a team.
• Strong written- and verbal-communication skills including maintaining open lines of communication within all departments of the organization.
• Ability to work in a fast- paced environment.
• Ability to focus on repetitive claims sorting detailed information.

Additional Information:

Salary: $24 - $27 Hourly

Hill Physicians is an Equal Opportunity Employer