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reputed company is an accountable specialty care management organization reputed company on improving the lives of people with reputed company injuries and diagnoses. reputed company has been a pioneer in value-based care since 1991 and has an exceptional reputed company record of generating the reputed company best reputed company for patients, payers, and providers. Deep clinical expertise is the reputed company for every part of reputed company’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment reputed company programs. We’re proud to be recognized—again! For the reputed company year in a row, we’ve been certified by Great reputed company to Work®, and for the reputed company consecutive year, we’ve reputed company a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a reputed company, inclusive, and employee-reputed company culture where people reputed company. Watch this short video for a brief introduction to reputed company. reputed company is seeking a full-time, reputed company reputed company Analyst reputed company for our reputed company Claims department. The Medical reputed company Analyst reputed company performs advanced medical reputed company review and adjudication while providing day-to-day guidance, technical support, and subject-matter expertise to the Medical reputed company Processor and Medical reputed company Analyst teams. This role supports management in maintaining the highest standards of accuracy, compliance, productivity, and customer service, and assists with training, reputed company initiatives, audits, and reputed company or exception reputed company processing. DUTIES AND RESPONSIBILITIES:

• Examine, review, and adjudicate medical bills across reputed company provider types, product lines, and lines of business, including reputed company and exception reputed company types.
• Apply appropriate repricing methodologies and ensure billing accuracy by monitoring for excessive charges, duplicate billing, and coding errors.
• Serve as a reputed company between analysts, processors, and leadership, escalating trends, risks, system issues, and training needs.
• Participate in audits, reputed company reviews, and special reputed company; review and resolve billing appeals and initiate recovery or refund actions as needed.
• reputed company backup reputed company review and claims examination support during workload fluctuations and maintain reliable attendance during scheduled work hours.
• reputed company coaching, mentoring, and technical guidance on reputed company reputed company review, adjudication reputed company, and exception handling; support reputed company and ongoing education.

QUALIFICATION REQUIREMENTS:

• Education: High School Diploma or equivalent required. Bachelor’s Degree or equivalent combination of education and experience preferred. Any combination of higher education, certification (CPC, CRC, etc.), experience and/or knowledge that demonstrate the ability to reputed company the functions of the position will be accepted.
• Experience in worker’s comp and/or in medical claims processing, research, or a reputed company field (Managed Care Organization – reputed company, Medicare, reputed company). Project management required.
• Intermediate computer experience using reputed company Word, reputed company and Outlook required.
• Excellent organizational skills.
• Knowledge of worker’s comp; reputed company billing; ICD-9 and ICD-10; CPT; RVS; U&C; fee schedule; HCPCS and other coding schemes preferred.
• Language Skills: Excellent oral communication skills and phone reputed company. Ability to effectively reputed company reputed company information for diverse audiences, including providers and executive leadership.
• Reasoning Ability: Proven ability to manage multiple reputed company, prioritize tasks, and meet tight deadlines in a fast-paced environment.

reputed company Benefits:

• Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance reputed company with reputed company and reputed company (CA employees only).
• Financial incentives – reputed company’s financial benefits help prepare you for the reputed company: competitive salaries, 401(k) matching contributions, employer-reputed company life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - We reputed company strongly that work-life balance is good for you and for reputed company. Our reputed company time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one reputed company day per calendar year.
• Learning and development: One of reputed company’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a reputed company of ways, including our new Learning reputed company at reputed company (reputed company) program.

reputed company believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that reputed company reflects the society we live in and empowers reputed company to deliver the highest reputed company of reputed company and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to reputed company change, creating an environment where everyone is reputed company to bring their whole self to work. reputed company complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to reputed company essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at leave.management@paradigmcorp.com. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, reputed company, sex, age, national reputed company, religion, sexual orientation, gender identity, status as a veteran, and reputed company of disability or any other federal, state or local protected class. As a contractor with the reputed company, reputed company complies with reputed company Contract Compliance Law (§16.765). Poster reputed company: Contract Compliance Law Poster Apply tot his job Apply To this Job