Claims Processor I

POSITION

Claims Processor I

Position Type: Temporary

Schedule: M-F, 8:00 am - 5:00 pm (Telecommute)

Assignment Length: Approximately 6-Months, possibly longer.

DESCRIPTION

Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Claims Processor I - Provider Claims is responsible for the pre-processing of medical claims. This includes validating member coverage, clearing system edits and categorizing a claim type to ensure the claim routes to the appropriate workgroup for adjudication.

Responsible for analyzing and processing claims EDI error queues prior to claim adjudication, correcting claim information and data integrity.

Processes professional claims as assigned by Supervisor or Manager based upon the team member's knowledge, experience and billing and coding training.

Prepare outgoing correspondence for the Claims Department including misdirected claims, additional information requests, and other mailings as needed.

Interface with other Departments, when necessary, regarding claims issues.

Participate in Claims Department staff meetings, and other activities as needed

Responsible for meeting performance measurement standards for productivity and accuracy.

Any other duties as required to ensure the company operations are successful.

Ensure the privacy and security of PHI (Protected Health Information) as outlined in Company policies and procedures relating to HIPAA compliance. REQUIREMENTS

Two (2) years of experience as a Data Entry Processor

Data Entry Processor experience preferably in an HMO or Managed Care setting. Medicare/Medi-Cal experience preferred

High school degree or GED required

Key Qualifications

Must have a valid California Driver's license

ICD-10 and CPT coding and general practices of claims processing preferred but not required. Prefer knowledge of capitated managed care environment

Strong analytical and problem-solving skills. Microsoft Office, Advanced Microsoft Excel. Excellent oral and written communication skills. Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills.

Ability to build successful relationships across the organization. Professional demeanor and strong organizational skills.

INDH