Anthem Claims Analyst Jobs (NOW HIRING)

The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children's Hospital Oakland (BCH Oakland), By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production supports all electronic claim production to various payers and clearinghouses, including Medicare, Medi-Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally. Electronic claim generation represents approximately 95% of all claims production. Monthly claims volume processed can reach up to 150,000 claims for hospital billing and up to 400,000 claims for professional billing. The position also supports the Electronic Remittance Advice (ERA) processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partners, and Community Connect Hospitals. In addition, this position also supports Electronic Funds Transfer (EFT) processes for UCSF, MGBS, BCH Oakland, LPPHC, UCPG, and Community Hospitals. The ERA/EFT represents approximately 80% of all inbound payment transactions to all supported service areas.
Frequent contact with all units in Patient Financial Services and other billing groups, as well as outside entities, such as Health Plans and EDI Clearing Houses, which partner with UCSF in EDI processes. Frequent access to the following applications: EPIC/APeX, Wells Fargo CEO portal, Clearinghouse EDI portals, ApplicationXtender, Cirius' Billing and Remittance Applications, and various payer sites.
Responsibilities
The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children's Hospital Oakland (BCH Oakland), By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production supports all electronic claim production to various payers and clearinghouses, including Medicare, Medi-Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally. Electronic claim generation represents approximately 95% of all claims production. Monthly claims volume processed can reach up to 150,000 claims for hospital billing and up to 400,000 claims for professional billing. The position also supports the Electronic Remittance Advice (ERA) processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partners, and Community Connect Hospitals. In addition, this position also supports Electronic Funds Transfer (EFT) processes for UCSF, MGBS, BCH Oakland, LPPHC, UCPG, and Community Hospitals. The ERA/EFT represents approximately 80% of all inbound payment transactions to all supported service areas.
Frequent contact with all units in Patient Financial Services and other billing groups, as well as outside entities, such as Health Plans and EDI Clearing Houses, which partner with UCSF in EDI processes. Frequent access to the following applications: EPIC/APeX, Wells Fargo CEO portal, Clearinghouse EDI portals, ApplicationXtender, Cirius' Billing and Remittance Applications, and various payer sites.
Qualifications
Requirements:

• High school graduate or GED certificate.
• One or more years of EDI/ERA experience in a hospital billing office or vendor environment with experience in 837I, 837P, and 835 file types.
• Three or more years of related administrative experience.
• An in-depth understanding of all aspects of electronic billing.
• Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
• Experience in computer operations, particularly file management and FTP processes.
• Knowledge of electronic billing systems (i.e., NGS online system, Cirius Prebill, and Remittance Manager, etc.).
• Basic knowledge of the Epic (APeX) systems.
• Ability to follow directions and written procedures.
• Must be a motivated individual with a positive attitude and exceptional work ethic.
• Maintain a working knowledge of copy and fax machines.
• Excellent knowledge of Microsoft Excel and Access.
• Basic knowledge of FTP functions.
• Computer software skills (i.e., Microsoft Office Suite).
• Knowledge of the mandated HIPAA regulations for security, PHI, and confidentiality is essential.
• Ability to work in Emeryville one day a week or more when required.
• Ability to legally work in the USA without any type of work Visa sponsorship.

Preferences:

• Insurance payment posting experience.
• Understanding of ICD10, CPT4, HCPCS, and DRG.
• Knowledge of insurance billing contracts, workers' compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal, and HIPAA compliance program regulations.

About Us
About UCSF
The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world's leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.
Pride Values
UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values.
In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available here.
Join us to find a rewarding career contributing to improving healthcare worldwide.
Equal Employment Opportunity
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.
Salary Information
The final salary and offer components are subject to additional approvals based on UC policy.
Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement.
To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html