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IEHP
IEHP
1001 – 5000 Darbinieki
ApdrošināšanaKonsultācijasLoģistika
IEHP ir reģionāls veselības aprūpes plāns, kas apkalpo personas un ģimenes ar zemiem ienākumiem Riversaidas un Sanbernardino apgabalos. Organizācija, kas dibināta 1995. gadā, nodrošina apdrošināšanas segumu, tostarp ar Medi-Cal, DualChoice un Covered California programmām, kā arī sadarbojas ar vietējiem ārstiem un veselības aprūpes iestādēm, lai savienotu biedrus ar medicīniskajiem pakalpojumiem. Tās uz kopienu vērstā pieeja ietver arī garīgās veselības atbalstu, fiziskās aktivitātes programmas un izglītošanu par labbūtību.
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Vakances uzņēmumā

Claims Specialist I, Provider Claims (California Remote)

Evaluate and resolve provider medical claims for Inland Empire Health Plan, including coverage and payment decisions, disputes, appeals, and adjustments.

USAmerikas Savienotās ValstisCAKalifornija
25 $ – 33 $ / stunda
AttālinātiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuApdrošināšanas atlīdzību speciālists

Apraksts

  • Review professional and institutional claims, including high-dollar and outpatient and inpatient claims
  • Determine coverage and payment levels
  • Resolve provider disputes and appeals
  • Prepare resolution letters
  • Process claim adjustment requests accurately and on time under standard procedures and regulatory guidelines
  • Contribute to payment adjustment projects
  • Manage complex claims as assigned
  • Support IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA accreditation

Prasības

  • Bring at least four years of experience evaluating and processing institutional and professional medical claims
  • Be proficient with medical claims systems, ICD-10 and CPT coding, medical authorization review, provider contract rate interpretation, and medical benefit coverage decisions
  • Have prior experience managing provider disputes, appeals, and claim adjustments
  • Experience in an HMO or managed care setting is preferred
  • Medicare and/or Medi-Cal experience is preferred
  • Experience in a managed care or government payer environment is helpful
  • Have a high school diploma or GED
  • Understand claims operations and customer service standards
  • Know ICD-9, ICD-10, CPT, and HCPC coding and general claims processing practices
  • Demonstrate strong analytical and problem-solving skills
  • Be proficient with Microsoft Office and advanced Microsoft Excel
  • Have strong written communication skills
  • Be able to analyze data and interpret regulatory requirements
  • Have excellent communication and interpersonal skills, strong organization, and data entry skills
  • Type at least 45 words per minute
  • Have excellent oral and written communication skills
  • Build effective working relationships across the organization
  • Maintain a professional demeanor
  • Show telephone courtesy and patience.
  • State-of-the-art onsite fitness center
  • Medical, dental, and vision insurance coverage

Priekšrocības

  • State-of-the-art onsite fitness center
  • Medical, dental, and vision insurance
  • Life insurance and short- and long-term disability options
  • Career advancement and professional development opportunities
  • Wellness programs supporting work-life balance
  • Flexible Spending Account for health care and childcare
  • CalPERS retirement plan
  • 457(b) plan with employer contribution match
  • Employer-paid life insurance
  • Pet care insurance

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