Astrana Health
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Claims Analyst
role at
Astrana Health Location:
1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation:
$75,000 - $95,000 / year Department:
Ops - Claims Ops
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
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:
Validate system configuration that it’s pricing claims correctly
Collaborate with configuration team if after testing configuration needs to be updated
Collaborate with contract with full intent of DOFR and contract rates
Maintain claim documentation and ensure system-generated errors are corrected prior to adjudication
Monitor and process claim exception and reconciliation reports as assigned
Analytical & Project Responsibilities:
Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunities
Develop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impact
Support cross-functional initiatives and operational projects to improve claims efficiency and compliance
Assist in the development and implementation of new workflows, tools, and system enhancements
Participate in project planning meetings, contributing subject matter expertise in claims operations and system configuration
Collaboration & Communication:
Serve as a liaison between Claims Operations, Provider Contracting, Finance, and IT departments to ensure alignment on claims processes and issue resolution
Communicate project progress, risks, and deliverables to leadership and stakeholders
Foster collaborative relationships across departments to drive process standardization and operational excellence
General:
Maintain required production and quality standards as defined by management
Support special projects and ad-hoc assignments related to claims and operational efficiency
Contribute to team success by sharing knowledge and supporting continuous improvement initiatives
Regular attendance and participation in on-site and virtual meetings are essential job requirements
Other duties as assigned
Qualifications
High School diploma or equivalent experience required, Bachelor’s degree preferred
Minimum 2 years experience as a Medical Claims Analyst or 7 years previous experience examining claims
Strong knowledge of CPT, HCPCS, ICD-10, and claims adjudication processes
Advanced skills in Microsoft Excel, Word, and familiarity with project management tools
Strong analytical, organizational, and documentation skills
Environmental Job Requirements and Working Conditions
Hybrid work structure with weekly in-office and remote work. Office location: 1600 Corporate Center Dr., Monterey Park, CA 91754.
Target pay range: $75,000.00 - $95,000.00 annually.
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Claims Analyst
role at
Astrana Health Location:
1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation:
$75,000 - $95,000 / year Department:
Ops - Claims Ops
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
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:
Validate system configuration that it’s pricing claims correctly
Collaborate with configuration team if after testing configuration needs to be updated
Collaborate with contract with full intent of DOFR and contract rates
Maintain claim documentation and ensure system-generated errors are corrected prior to adjudication
Monitor and process claim exception and reconciliation reports as assigned
Analytical & Project Responsibilities:
Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunities
Develop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impact
Support cross-functional initiatives and operational projects to improve claims efficiency and compliance
Assist in the development and implementation of new workflows, tools, and system enhancements
Participate in project planning meetings, contributing subject matter expertise in claims operations and system configuration
Collaboration & Communication:
Serve as a liaison between Claims Operations, Provider Contracting, Finance, and IT departments to ensure alignment on claims processes and issue resolution
Communicate project progress, risks, and deliverables to leadership and stakeholders
Foster collaborative relationships across departments to drive process standardization and operational excellence
General:
Maintain required production and quality standards as defined by management
Support special projects and ad-hoc assignments related to claims and operational efficiency
Contribute to team success by sharing knowledge and supporting continuous improvement initiatives
Regular attendance and participation in on-site and virtual meetings are essential job requirements
Other duties as assigned
Qualifications
High School diploma or equivalent experience required, Bachelor’s degree preferred
Minimum 2 years experience as a Medical Claims Analyst or 7 years previous experience examining claims
Strong knowledge of CPT, HCPCS, ICD-10, and claims adjudication processes
Advanced skills in Microsoft Excel, Word, and familiarity with project management tools
Strong analytical, organizational, and documentation skills
Environmental Job Requirements and Working Conditions
Hybrid work structure with weekly in-office and remote work. Office location: 1600 Corporate Center Dr., Monterey Park, CA 91754.
Target pay range: $75,000.00 - $95,000.00 annually.
#J-18808-Ljbffr