Full Circle Health Network · 14 hours ago
Claims Analyst
Sacramento, CA
Full-time
Hybrid
Mid Level
$75K/yr - $85K/yr
3+ years expFull Circle Health Network is an integrated network of nonprofit providers delivering community-based services in California. They are seeking a Behavioral Health Claims Analyst to manage claims operations analysis, monitor reimbursement trends, and implement process improvements to enhance claims outcomes.
Government Administration
Responsibilities
Research, create, and maintain reimbursement policy guidance, operational documentation, and controls to ensure compliance with contractual and regulatory requirements
Analyze claims and reimbursement data to identify patterns, inconsistencies, and root causes, then develop, implement, and monitor process improvements to address findings
Establish and maintain claims quality controls, monitor accuracy and compliance outcomes, and recommend operational updates to reduce errors and improve performance
Identify systemic claims issues and lead cross-functional collaboration with providers, plans, and internal teams to resolve escalations and implement long-term solutions
Navigate and utilize claims and billing systems to monitor performance, evaluate trends, and drive workflow and process improvements, including escalation management and follow-through
Stay current on claims and billing regulations, guidelines, and payer requirements; assess operational impact; and recommend and implement updates to workflows and guidance
Develop, document, and improve claim routing standards, workflows, and operating procedures, and monitor adherence through performance review and corrective action as needed
Generate reports and documentation for internal and external stakeholders, summarize performance findings, and provide actionable recommendations and risk flags to support decision-making
Participate in ongoing educational opportunities to continuously update and enhance job knowledge, ensuring best practices are applied as policies, payer requirements, and systems evolve
Qualification
Required
Bachelor's Degree in a related field or equivalent experience
3–5 years experience in health or behavioral healthcare claims and billing, delegation oversight, claims operations performance improvement, and/or escalation management
Preferred
Graduate degree or course of studies in business or health care management
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