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Partnership HealthPlan of California · 2 weeks ago

Claims Business Analyst

Sonoma County, CA

Contract

Onsite

Entry Level

$37.22/hr - $46.53/hr

2+ years exp

Partnership HealthPlan of California is seeking a Claims Business Analyst to design, produce, and analyze operational data for the Claims Department. The role involves providing organizational and technical support, troubleshooting system issues, and ensuring compliance with health plan policies and procedures.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Creates and runs all reports that are required from retro system configuration updates to identify all impacted claims for Recovery of monies or for adjustments to previously paid claims

Serve as a liaison for Claims to Configuration, Contracting, and Finance

Maintains in-depth knowledge of Partnership systems from a technical and end-user perspective

Performs analysis, design, configuration, and testing of assigned systems

Uses various resources to troubleshoot and resolve system issues

Tests and takes part in implementation of new releases and upgrades

Analyzes new systems and functionality and makes recommendations to business users and IT

Writes processes and procedures

Track all recovered monies through the claims process

Creates and runs all reports that need to be ran to identify provider trends

Performs system audits to ensure the system is behaving as expected

Performs internal audits of all Partnership Provider contracts 90 days post implementation

Run ad hoc reports as requested

Prepares monthly summary of System audits

Prepares quarterly summary of Contract audits

Monitor health plan policies and procedures and assist with documenting Claims related business requirements and decisions that result from configuration and other change driven sources

Participates in system upgrade/update testing as needed

Develops short and/or long-term resolutions by identifying root causes using reporting and other data files available

Troubleshoot and perform research on medium to moderately complex claims processing issues and projects

Provide recommendations on the design of claim payment system configuration

Serve all stakeholders through continuous monitoring and auditing of claim processing, educational and problem-solving support

Maintain regular and consistent contact with operations management, clinical leadership, and appropriate health plan leaders

Analyze, interpret, and recommend updates to policy and procedures applicable to managed care reimbursement payment methodologies using payment rules and requirements from sources such as CMS, California State Medi-Cal, and DHCS

Other duties as assigned

Qualification

Health Rules PayerBusiness Intelligence softwareData reportingDatabase supportCommunicationDetail-orientedOrganizational skills

Required

Associates degree in related field

Minimum of two years healthcare experience, preferably in managed care environment

Experience with Health Rules Payer, or similar claims payment system

Knowledge of Business Intelligence or similar reporting software

Demonstrates aptitude for acquiring new technical skills in data reporting and database support

Detail-oriented with strong organizational skills

Excellent written and oral communication skills

Ability to work on multiple assignments, prioritize work, and meet established timelines

Ability to use a PC with standard software packages and a 10 key calculator

Ability to move, care, and/or lift objects of varying sizes weighing up to 25 lbs

Must be able to operate a car for company business

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees