Full Circle Health Network ยท 1 day ago
Claims Analyst
Sacramento, CA
Full-time
Hybrid
Entry, Mid Level
$36.06/hr - $40.87/hr
2+ years expFull Circle Health Network is an integrated network of nonprofit providers delivering community-based services in California. The Claims Analyst role involves managing claims and encounter processes, ensuring compliance, and collaborating with internal teams to enhance operational performance.
Government Administration
Hiring Manager
Pamela Lucas
Responsibilities
Review incoming claims/encounter submissions for completeness, accuracy, and compliance with payer requirements (e.g., Medi-Cal managed care, delegated arrangements, and contractual terms)
Identify and correct errors related to eligibility, authorization, coding, modifiers, provider information, and documentation requirements
Track claims status through lifecycle stages (submitted, accepted, denied, pended, paid) and coordinate follow-up actions
Support reconciliation of remittance advice, payment variance, and denial data as needed
Analyze denials and payment issues, determine root cause, and recommend corrective actions
Coordinate with provider billing teams, internal operations, and payers to resolve claim issues within required timeframes
Maintain documentation of outreach, resolutions, and recurring issues; escalate complex issues appropriately
Support appeals and reconsiderations by gathering required documentation and ensuring submissions meet payer requirements
Monitor claims/encounter quality metrics (e.g., clean claim rate, denial rate, timeliness, resubmission volume)
Generate and maintain tracking logs and dashboards (Excel/Sheets) to support operational oversight
Identify workflow gaps and recommend process improvements that reduce rework and prevent recurring denials
Support audits and reporting requests by providing accurate claim data and documentation
Provide clear and timely communication to providers on claim issues, documentation gaps, and resolution steps
Partner with Network Operations, Finance, Compliance, and IT teams to improve systems alignment and workflow efficiency
Participate in payer/provider meetings as needed to resolve systemic issues and improve performance
Contribute to provider guidance materials and internal SOPs to support consistent submissions
Ensure all work complies with HIPAA and applicable state/federal privacy regulations
Follow organizational policies for data security and the handling of protected health information (PHI)
Maintain accurate records and ensure reporting is complete and audit-ready
Qualification
Required
2+ years of experience in claims processing, revenue cycle, billing, or claims/encounter analysis (healthcare, behavioral health, or managed care preferred)
Strong working knowledge of claims workflows, denials, eligibility, authorizations, and documentation standards
Proficiency with Excel/Google Sheets (filters, pivot tables, lookups preferred)
Ability to interpret payer policies and apply them to claims resolution and documentation requirements
Strong communication skills and ability to work collaboratively across teams
High attention to detail and ability to manage multiple priorities in a deadline-driven environment
Preferred
Experience working with Medi-Cal managed care plans and/or delegated provider networks
Knowledge of CPT/HCPCS, ICD-10, modifiers, and authorization workflows
Experience with EHR and/or claims submission platforms (clearinghouses, payer portals, etc.)
Familiarity with CalAIM programs and community-based behavioral health services
Experience in nonprofit or community-based healthcare settings
Benefits
Comprehensive benefits package including health, dental, vision, and retirement contributions
Flexible hybrid work model with statewide impact
Opportunities for professional development and growth within a mission-driven organization
Company
Full Circle Health Network
Full Circle Health Network is an integrated network of nonprofit, nationally accredited providers delivering coordinated, community-based services to vulnerable children, individuals and families across California.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase