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Claims Processor Ii- Medi-Cal (Remote)
Company | Inland Empire Health Plan |
Address | , Rancho Cucamonga |
Employment type | |
Salary | |
Expires | 2023-11-30 |
Posted at | 8 months ago |
Job Requisition ID: 9975
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
A reasonable salary expectation is between $45,884.80 and $55,993.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
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