Position Summary: Maintains positive working relationships with our internal and external customers, health plans, providers and/or members by seeking a partnership approach that will meet the company goals and vision. The Claims Compliance Analyst will coordinate Health Plans audits activities with preparation and provide preliminary results on non-compliant claims to the Claims Director. Assists with an audit control checklist for prevention of claims untimeliness of payment. Collaborates in conjunction with the Managed Care Management Team and other auditors, to ensure QA programs are aligned with claims operations and other areas that have direct impact with claims to prevent non-compliance. Adheres to internal department standard operating procedures and applies standard industry guidelines in accordance with regulatory agencies (state and federal). Prepares and submits all monthly, quarterly and as needed reporting to the health plans (Monthly Timeliness, ODAGs, Part C, claims universe, etc.)
Claims Compliance Analyst • Whittier, CA, United States
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