Job description
Who You Are
You are devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of your patients. You are passionate about getting to the root cause of a patient's conditions, removing social determinants of healthcare, and ensuring the highest possible quality of life for those in your care. You don't want to sacrifice quality over quantity, and you aim to provide the same level of care and commitment to your patients that you would to your own family member. Does this sound like you? If so, we should talk.
Who We Are
We are Honest Medical Group, a groundbreaking team of healthcare professionals focused on making a major impact in healthcare. At Honest we align every aspect of our health plans to support patients seeing our providers; we drive health improvements, create a seamless member experience, and eliminate duplicative costs. We listen to the needs of our patients and our employees, continually working to push beyond the status quo in which the care system manages patients today. For us, it's all in an Honest day's work.
Your Role
You are responsible for building and operating high quality, timely and compliant claims and capitation workflows and processes in partnership with our software provider for the ACO Reach line of business. This position will build, from the ground up, the claims analysis and escalation workflows required to ensure that our providers have the best possible experience when their claims are submitted and processed. You will work closely with stakeholders from our IT, Network, Operations and Finance teams to ensure that the proper processing of activities related to Claims and Capitation processing.
Primary functions for the Claims Analyst include:
- Uphold all contractual, state, and regulatory agency guidelines and standards, including CMS
- Ensure the highest standard of quality and compliance is delivered in our claims and capitation processes
- Establish and maintain oversight and reporting for claims and capitation processing
- Oversee and complete outstanding daily and weekly claims tasks
- Work closely with members of the Operations, Finance, and IT teams to prioritize and complete outstanding claims-related tasks
- Work closely with Network operations on provider data claims pends to resolve outstanding issues and questions
- Support and drive a culture of excellence in claims and capitation processing
- Ensure stakeholders are educated and informed about the specific operational and compliance needs of Claims in service of the best possible member and provider experience
Qualifications:
- Minimum 3-5 years of claims experience
- Medicare Advantage or DCE/ACO Reach experience bonus
- Experience working with operational reporting and metrics to help prioritize daily work
- You accept that things change quickly in a startup environment and are willing to pivot quickly on priorities
- Experience in a team-based service environment
- Ability to work independently and in a relatively unstructured manner
- Excellent communication skills
- Proven ability to develop and manage daily queue of tasks
- Proficient in Office Suite
- Minimum pay starts at $65,000 and increases from there depending on experience.
How You are Supported
- You will benefit from Honest's exceptional total rewards package, including competitive base pay with bonuses, generous paid time off policy including 12 paid holidays per year, reimbursement for continuing medical education, 401k with 4% match, health, dental, and vision insurance.
- Family friendly policies that support paid parental leave and flexible work arrangements
- As a team member you'll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with Honest.
- You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Honest's high-quality, value-based, care model.
Honest is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about your EEO rights as an applicant (Opens in a new window) .
Honest will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants. United States Department of Labor. Learn more (Opens in a new window).
Honest is committed to working with and providing reasonable accommodations to job applicants with physical or mental disabilities. Applicants with a disability who require a reasonable accommodation for any part of the application or hiring process should email JOliver@HonestMedicalGroup.com for assistance. Reasonable accommodations will be determined on a case-by-case basis.
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