Claim Analyst - PHMI EE Benefits in Ontario, CA at Prime Healthcare

Date Posted: 1/10/2021

Job Snapshot

  • Employee Type:
  • Location:
    3480 East Guasti Road
    Ontario, CA
  • Job Type:
  • Experience:
    1 to 2 years
  • Date Posted:

Job Description

Responsibilities The Claims Analyst is responsible for evaluation of billing, coding and supporting documentation of physicians, facilities and ancillary providers. Can communicate clearly and efficiently by phone, in person and email with the TPA claims administrator and other in-house staff members. Is current with ERISA and state regulation standards and reports irregularities with billing, claims, documentation, etc. Reviews and reports on physician coding and reports to Manager to initiate corrective action plans as necessary. Is available for all Benefits staff for coding, regulation and documentation review. Maintains all necessary information needed to comply with insurance billing requirements. Is certified AHIMA, CPC or equivalent.



Education and Work Experience


Required qualifications:

  1. 1-2 years of experience in coding/billing setting and HMO/gatekeeper IPA setting.
  2. High School Diploma or GED
Preferred qualifications:

  1. CPC (Certified Professional Coder) or equivalent preferred

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: