Job Openings in Sacramento County and Beyond
Responsibilities: Reviews and processes medical claims in accordance with company policies and procedures. Determines coverage, completed eligibility verifications, and identified discrepancies. Reviews claims or referral submissions to determine, review, or apply appropriate guidelines, member identification processes, provider selection, and claim coding, including procedure, diagnosis and pre-coding requirements. Checks for erroneous items or codes and missing information and corrects according to policies and procedures. Maintains claims production standard, and consistently meets quality standards. Receives, sorts and organizes incoming claims for scanning. Updates and corrects denied claims. Prepares and mails out claims correspondence daily. Researches and updates and/or corrects member eligibility.
Requirements: 3 years of claims adjudication or claims processing experience. 3 year in managed care claims processing. HMO/IPA experience strongly preferred. Familiarity with ICD-9/10, HCPCS, CPT coding, modifiers, DMHC regulations, facility and professional claim billing practices. Ability to maintain quality goals in a production driven environment. Follow through on commitments and meets deadlines. Work is thorough, accurate, and effective. Excellent communication skills, including both oral and written. Must have mid-level skills in Microsoft software (Word, Excel, Outlook.) Ability to pass on boarding requirements including both drug and background screening.