Job Details

Job Title - Claims Processor

Job Location - Whittier, CA 90601

Hourly Pay

• $30/hr

Shift

• Day 5x8-Hour (07:00 - 15:30)

Job Description -

SPECIFIC SKILLS NEEDED

Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills.

Required:

Formal training will be indicated by a high school diploma or equivalent;

Four years medical claims processing.

DUTIES AND RESPONSIBILITIES

1. Safeguards and preserves the confidentiality of patient's protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies.

1. Ensures a safe patient environment and adherence to safety practices per policy.

1. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant other when administering care.

1. Assist the Claims Director in the training and education of the Claims department staff

1. Coordinate the generation and review of claims audit, status and pending claims reports ensuring authorized claims are paid in accordance with company guidelines

1. Investigate, process and track payment adjustments including refunds, overpayments and underpayments

1. Act as a confidential and professional resource for group providers and other staff.

1. Act as a resource for providers, members, insurance carriers, attorneys and co-workers, researching and responding to questions in a timely manner

1. Create, maintain and generate system reports

10.Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans