County of Orange-Claims QA Analyst

6/20/2022 11:19:56 AM 436


See Position Description


Orange, CA

Closing date and time

8/14/2022 at 11:59 PM Pacific Time (US & Canada); Tijuana

click to apply

Experience & Education:


• Bachelor's degree in Healthcare Administration or relevant field, or the equivalent combination of education and/or related experience required.

• 2 years of medical health claims processing experience required.

• 2 years audit experience in Audit & Oversight, Claims Administration, Customer Service, or applicable area required.


Knowledge of:


• Industry pricing methodologies, such as Resources-Based Relative Value Scale (RBRVS), Medicare/Medi-Cal Fee schedule, All Patient Defined Diagnosis Related Group (AP-DRG), Ambulatory Payment Classification (APC), Healthcare Common Procedure Coding Systems (HCPCS) codes.

• International Classification of Diseases (ICD)-10, Current Procedure Terminology (CPT), and Revenue Codes.

• Managed Care compliance for Medi-Cal and Medicare.

• Center for Medicare & Medicaid Services (CMS) and Medi-Cal/Department of Healthcare Services (DHCS) claims processing regulations.

• Fundamental principles of writing and grammar, including proper report and correspondence format, correct spelling, and proper work usage, grammar, punctuation, and sentence structure.


Department(s): Claims Administration

Reports to: Manager, Claims

FLSA status: Non-Exempt

Salary Grade: F - $24.52- $35.43 ($51,000 - $73,700)


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Job Location: Orange, California


Position Type:


To apply, visit https://apptrkr.com/3136908


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