Claims Analyst I - 25-194

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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.

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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

Responsible for providing accurate and timely claims processing and adjustment administration to ensure that all physicians receive uniform consistent claims administration in accordance to Health Plan (HP) contracts and HPMG's policies.

Job Responsibilities

• Screen all claims / adjustments to ensure the following :
• Claim / adjustment contains pertinent and correct information for processing / adjusting.
• Services are either HPMG or HP Risk's financial responsibility.
• Member is eligible for coverage on the date(s) of service.
• Services have the required referrals / authorizations.
• Accurate final claims adjudication by using on-line computer claims payment system. This includes research on previously processed claims when needed.
• Identify billing patterns, processing errors, and / or system issues that inhibit the final adjudication of claims.
• Utilize the CSR module to document adjustments and generate letters.
• Adjudicate claims / adjustments on the IDX system according to HPMG guidelines.
• Maintain productivity goal.
• Maintain a 97% payment accuracy rate and 98% non-payment accuracy rate.
• Coordinate and resolve claims / adjustments issues related to claims processing with the appropriate departments as required.
• Determine benefits using automated-system controls, policy guidelines, DFRs, and HMO Fact Sheets.
• Complete special projects as assigned to meet department and company goals.

Required Experience

Required Education

Additional Information

Salary : $24 - $27 Hourly

Hill Physicians is an Equal Opportunity Employer