Claims Processor II- Medi-Cal (Remote)

Position Summary/Position

Under the direction of the Claims Production Manager and Claims Supervisor, the Claims Processor II is responsible for receiving claims and processing the claims in an expedient manner.

Major Functions (Duties and Responsibilities)

1. Responsible for non-delegated provider claims verification and adjudication.
2. Adjudicate all professional and outpatient facility claims including COB, denials, and reduction in service notifications
3. Interface with other IEHP Departments, when necessary, regarding claims issues.
4. Participate in Claims Department staff meetings, and other activities as needed
5. Responsible for meeting the performance measurement standards for productivity and accuracy for one specific type of claim form, professional (HCFA) or institutional (UB.)

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Two (2) years experience in examining and processing medical claims; professional or institutional.

Preferred Experience

Medicare/Medi-Cal experience preferred. Claim adjustments, provider appeals and/or disputes preferred.

Education Qualifications

High school diploma or GED required.

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

ICD-9 and CPT coding and general practices of claims processing. Prefer knowledge of capitated managed care environment.

Skills Requirement

Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills, strong organizational skills.

Abilities Requirement

Professional demeanor.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence.

Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Physical Requirements