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IEHP
IEHP
1001 – 5000 Zaposleni
LogistikaSvetovanjeZavarovanje
IEHP je regionalni zdravstveni načrt, ki nudi storitve posameznikom in družinam z nizkimi dohodki v okrožjih Riverside in San Bernardino. Organizacija, ustanovljena leta 1995, zagotavlja zdravstveno kritje prek programov Medi-Cal, DualChoice in Covered California. Sodeluje z lokalnimi zdravniki in zdravstvenimi ustanovami ter članom pomaga pri dostopu do zdravstvenih storitev. Njen pristop, usmerjen v skupnost, vključuje tudi podporo duševnemu zdravju, programe telesne vadbe in izobraževanje o zdravju ter dobrem počutju.
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Delovna mesta v podjetju

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.

USZdružene države AmerikeCAKalifornija
25 $ – 33 $ / ura
Na daljavoPolni delovni časSrednja ravenSeniorZahtevani Jezik: angleščinaSpecialist za obravnavo škod

Opis

  • 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

Zahteve

  • 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

Ugodnosti

  • 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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