Claims Analyst

Description

Job Title : Claims Analyst

Department : Ops – Claims Ops

About the Role :

We are currently seeking a highly motivated Claims Analyst. This role will report to the Director - Claims and enable us to continue to scale in the healthcare industry.

What You'll Do

Claims Review & Processing :

• Conduct comprehensive review and analysis of pended or denied claims for billing accuracy, contract compliance, and adherence to claims processing guidelines
• Process and adjudicate non-institutional and institutional claims for multiple lines of business (e.g., Medicare, Medi-Cal, Commercial, etc.)
• Validate provider contracts, fee schedules, pricing configurations, and ensure updates are properly reflected in the system
• Research, adjust, and resolve complex claim issues such as duplicate billing, unbundling of services, incorrect coding, or payment discrepancies
• Review claims utilizing ICD-10, CPT, and HCPCS codes to confirm proper billing and medical necessity
• Verify member eligibility and coordination of benefits, including Medicare primary and other secondary coverage
• Identify and escalate claims with high financial or compliance risk for management review

Data & Systems Management :

Analytical & Project Responsibilities :

Collaboration & Communication :

General :

Qualifications

Environmental Job Requirements and Working Conditions

Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.