ul>Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and. Ability to quickly acquire in-depth knowledge of various systems related to claims processing, membership, provider, and benefits at Partnership. p>The Payment Compliance & Contract Management (PCCM) Analyst is responsible for maximizing reimbursement by identifying variances between posted and expected revenue for managed care, government contracts, and other payers. - Analyzes contract reimbursement, identifying variances, trends in underpayments/overpayments, denials, and revenue leakage to support maximization of reimbursement.
San Jose, California30+ days ago Please note that in order to verify work authorization as is required by Federal law (I-9 process), all new employees must complete a live video verification with their selected IDs and provide photos of these selected IDs within their first 3 days of employment. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. p>The Senior Health Informatics Analyst will create and develop essential department reports and deliverables to ensure timely dissemination of accurate information to organizational decision-makers; provide data analysis, interpretation, and consultation to maximize the use of organizational data (claims, authorizations, capitation, enrollment, pharmacy, financial, EMR, clarity, program engagement, abstraction data) in order to support needs of senior management, operational management, finance lead and healthcare leadership. Marquez%40pihhealth.org%7C1234f44474844f48e14a08d9ebe9053e%7Ca58ef208b7dc40aa8f166eb35263cb1c%7C0%7C0%7C637800208320708287%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=itjUBuUESomy5k8fnqLUf2EuyxVcl4xXjgaKar5hjhA%3D&reserved=0" rel="nofollow">PIHHealth.org or follow us on Los Angeles, CA30+ days ago Coding/Compliance Certification preferred • Resolute Hospital Billing Administration, Charge Router and/or Charge Master Epic Applications Certifications, preferred • Three to five years of related health care administration/financial or revenue cycle analysis experience required. Will support the Revenue Cycle Operations Department through the identification, quantification and execution of special projects identifying areas of increased net revenue opportunities related to charging. 113,000 - $153,000 AnnuallyThe statements contained in this job description reflect general details as necessary to describe the principal functions of this job. The Senior Regulatory Compliance & Revenue Cycle Analyst is responsible for advancing compliance across payer relationships, reimbursement practices, and healthcare regulatory frameworks, while supporting enterprise-wide GRC privacy and compliance initiatives. The Senior Regulatory Compliance & Revenue Cycle Analyst is responsible for advancing compliance across payer relationships, reimbursement practices, and healthcare regulatory frameworks, while supporting enterprise-wide GRC privacy and compliance initiatives. This is a high-impact, cross-functional role ideal for a compliance professional who understands how regulatory requirements translate into real-world healthcare operations, financial sustainability, and patient outcomes. |