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Claims Processor I

Alura Workforce Solutions

Rancho Cucamonga, CA

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JOB DETAILS
SKILLS
Adjudication, Analysis Skills, Billing, Claims Management, Claims Processing, Communication Skills, Corporate Policies, Current Procedural Terminology (CPT), Data Entry, Data Quality, Driver's License, Electronic Data Interchange (EDI), HIPAA (Health Insurance Portability and Accountability Act), Health Maintenance Organization (HMO), ICD-10, Information/Data Security (InfoSec), Interpersonal Skills, Mail Processing, Managed Care, Medi-Cal, Medicare, Microsoft Excel, Microsoft Office, Microsoft Windows Operating System, Organizational Skills, Performance Metrics, Presentation/Verbal Skills, Privacy Controls, Problem Solving Skills, Secondary School, Writing Skills
LOCATION
Rancho Cucamonga, CA
POSTED
30+ days ago
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.
  1. Responsible for analyzing and processing claims EDI error queues prior to claim adjudication, correcting claim information and data integrity.
  2. Processes professional claims as assigned by Supervisor or Manager based upon the team member's knowledge, experience and billing and coding training.
  3. Prepare outgoing correspondence for the Claims Department including misdirected claims, additional information requests, and other mailings as needed.
  4. Interface with other Departments, when necessary, regarding claims issues.
  5. Participate in Claims Department staff meetings, and other activities as needed
  6. Responsible for meeting performance measurement standards for productivity and accuracy.
  7. Any other duties as required to ensure the company operations are successful.
  8. 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.

About the Company

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Alura Workforce Solutions