Claims Research Analyst - 25-208

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:

Primarily responsible for researching Claims Research & Resolution Unit’s (CRRU) incoming mail while identifying PDR’s and adjustments. Also responsible for researching accurate and timely claims processing administration in accordance to Health Plan (HP) contracts and HPMG’s policies.

Job Responsibilities

• Screen and research all claims to ensure the following:
• Claim contains pertinent and correct information for processing PDRs and adjustments.
• Accurate final claims adjudication by using on-line computer claims payment system. This includes research on previously processed claims when needed.
• Maintain 98% accuracy rate.
• Maintain 100% productivity goal.
• Utilize Epic to document PDRs/adjustments as needed.
• Develop a CRM and generate letters as appropriate.
• Complete special projects as assigned to meet department and company goals.
• Identify billing patterns, processing errors, and/or system issues that inhibit the final adjudication of claims.

Required Experience

• One year internal/external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO) or HP
• 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

Required Education

• High School Diploma/GED required

Additional Information

Salary: $23 - $26 Hourly

Hill Physicians is an Equal Opportunity Employer