Job Details

Job Type

Full-time

Description

Who We Are

Innovative Integrated Health (IIH) is a mission-driven healthcare organization dedicated to helping frail, underserved, and multiethnic seniors live safely and independently at home with dignity. Through the Program of All-Inclusive Care for the Elderly (PACE) model of care, we deliver high-quality, personalized healthcare and supportive services that improve quality of life across the communities we serve.

At IIH, our work is rooted in compassion, cultural understanding, and deep respect for those in our care. Team members play a vital role in supporting seniors throughout Central and Southern California-delivering care that's not only clinically excellent, but also personal, coordinated, and community-based.

When you join IIH, you become part of a team committed to making a real difference in the lives of older adults-every single day.

Benefits

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Job Summary:

The Claims Analyst is responsible for monitoring liability claims, verifying and updating information on submitted claims. Reviews contract information and policies to determine which charges are eligible for reimbursement. Ensures completeness and accuracy with claims processing in order to support the organization's revenue cycle.

Essential Job Functions

Duties include, but are not limited to:

• Reviews c laims and appeals for accuracy, completeness, and eligibility.
• Analyze and audit claims to ensure compliance and provide solutions to resolve claims errors.
• Creates financial estimates on a weekly basis using Microsoft Excel.
• Provides feedback and justification of denied claims to providers, as needed.
• Aids providers on how to submit claims and verification of participant's eligibility.
• Conducts basic contract review to confirm payment rates.
• Collaborates with other departments in the organization.
• Requests monthly inventory tracker from TPA (Third Party Administrator)
• Conducts follow-up activity for claims held until the claim is closed.
• Confirms that claims are associated with pre-authorizations from the Interdisciplinary Team (IDT) and/or Primary Care Provider.
• Conducts coordination of benefits, insuring that claims impact primary and secondary insurance, as appropriate.
• Reviews and analyzes claims loss, expense reserves and reconciles claims reports with authorization sheets.
• Processes new claims and disseminates the claims to TPA.
• Reports claims issues to IDT, Primary Care Providers, Vice President of Finance and other entities, as appropriate.
• Assists Claims Supervisor to identify exposures to the company and reports to senior-level management on pending claims and litigation that may have an adverse impact on corporate goals.
• Assists Claims Supervisor as a liaison between the TPA, provider network, insurance companies and other entities as needed.
• Checking pricing of claims through contracted rates and Medicare/Medicaid fee schedules.
• Demonstrates workplace behavior that promotes organizational core values of honesty and integrity, respect for others, encouragement, high quality care and patient-centeredness.
• Attend and participate in staff meetings, in-services, projects, and committees as assigned.
• Adhere to and support the center's practices, procedures, and policies including assigned break times and attendance.
• Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
• Be flexible in schedule of hours worked.
• May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver's License is required.

Knowledge, Skills and Abilities

• Proficient knowledge of computer skills. MS Office (Word, Excel, Access, PowerPoint, Publisher and Outlook). Candidates will take a Microsoft Office proficiency exam before being offered a position.
• Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
• Excellent written, grammatical, reading comprehension and verbal skills required.
• Ability to quickly learn department policies, procedures, goals, and services.
• Skill: Attention to detail and accuracy.
• Ability to change priorities regularly.

Working Conditions and Physical Demands

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to access all areas of the center throughout the workday.
• Ability to lift a minimum of 35 occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance from another qualified employee when attempting to lift or transfer objects over 50 pounds.
• Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
• Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.

Requirements

Requirements

Qualifications

MUST LIVE IN ANAHEIM, BAKERSFIELD, OR FRESNO, CA AREA

• 2+ years of professional experience processing and analyzing claims is strongly preferred.
• Ability to present information in one-on-one and group settings.
• Ability to communicate information in a professional and confident manner.
• Demonstrated ability in critical thinking, self-initiative, and self-direction.
• Understanding of physiology, medical terminology, and disease process. strongly preferred.
• Demonstrated PC skills in Word, Excel, and Microsoft Access
• Detail oriented
• Experience with the QuickCap claim system is preferred.

Education

• A minimum of a High School Diploma with two (2) years of relevant experience required.
• A bachelor's degree is preferred.

Core Values

• Respect at the core of our interactions.
• Honesty and Integrity with every endeavor
• Patient - Centered care aligned with participant values, beliefs, and preferences.
• Encouragement that motivates and empowers others to be the best they can be.
• Quality Care that is efficient, transformative and innovative.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Salary Description

$19 - $22.50/hr