Temporary Claims Specialist II - Provider Claims

LanceSoft Inc

Rancho Cucamonga, CA(remote)

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JOB DETAILS

SALARY

$27.43 Per Hour

SKILLS

Analysis Skills, Billing, Claims Processing, Communication Skills, Customer Support/Service, Data Entry, Driver's License, Establish Priorities, HIPAA (Health Insurance Portability and Accountability Act), Health Maintenance Organization (HMO), Health Plan, High School Diploma, Identify Issues, Information/Data Security (InfoSec), Interpersonal Skills, Managed Care, Medi-Cal, Medicare, Microsoft Excel, Microsoft Office, Operations Planning, Organizational Skills, Presentation/Verbal Skills, Privacy Controls, Problem Solving Skills, Provider Contracting, Research Skills, Root Cause Analysis, Time Management, Training/Teaching, Trend Analysis, Typing, Writing Skills

LOCATION

Rancho Cucamonga, CA(remote)

POSTED

30+ days ago

Title: Temporary Claims Specialist II - Provider Claims
Assignment Length: Six Months

WORK LOCATION:10801 6th St STE 120, Rancho Cucamonga, CA 91730

Key Responsibilities:

Review and process provider dispute resolutions according to state and federal designated timeframes.
Review and assist with applying identified refunds submitted by the CART team.
Research reported issues; adjust claims and determine the root cause of the dispute.
Draft written responses to providers in a professional manner within required timelines.
Independently review and price complex edits related to all claim types to determine the appropriate handling for each including payment or denial.
Complete the required number of weekly reviews deemed appropriate for this position.
Respond to provider inquiries regarding disputes that have been submitted.
Maintain, track, and prioritize assigned caseload through IEHP s provider dispute database to ensure timely completion.
Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed.
Communicate with a variety of people, both verbally and in writing, to perform research, gather information related to the case that is under review.
Recommend opportunities for improvement identified through the trending and analysis of all incoming PDRs.
Coordinate with other departments as necessary to facilitate resolution of claim related issues. Identify and report claim related billing issues to various departments for provider education
Any other duties as required to ensure Health Plan operations are successful.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Qualifications

Education & Requirements
Four (4) years of experience in a managed care environment in the area of claims processing; appeals & adjustments, and customer service, preferably in an HMO or Managed Care setting
A thorough understanding of medical claim processing and customer service standards
Medi-Cal/Medicare experience and prior experience in a lead role preferred
High school diploma or GED required

Key Qualifications

Must have a valid California Driver's license
Understanding of claim appeal process, provider contracts, claim system functionality and medical claim processing practices
Strong analytical and problem-solving skills
Microsoft Office, Advanced Microsoft Excel
Microcomputer skills, proficiency in Windows applications preferred
Excellent oral and written communication skills
Excellent communication and interpersonal skills
Customer service skills and skilled in data entry required
Typing a minimum of 45 wpm
Ability to build successful relationships across the organization
Professional demeanor and strong organization skills
High degree of patience

About the Company

LanceSoft Inc

We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc).

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.

COMPANY SIZE

2,000 to 2,499 employees

INDUSTRY

Staffing/Employment Agencies

FOUNDED

2000

WEBSITE

http://www.lancesoft.com/