Temporary Claims Processor II

Inland Empire Health Plans; California (MO); Hybrid; USD 40,000 - 65,000; Full time

Job summary

Join a forward-thinking organization dedicated to healing and inspiring the human spirit! This temporary role offers the chance to support claims processing in a dynamic healthcare environment. You will be responsible for adjudicating outpatient claims, ensuring accuracy and expedience. With a commitment to quality, you will contribute to the organization's goals while enjoying the flexibility of potential remote work. If you have a passion for healthcare and a knack for detail-oriented tasks, this opportunity is perfect for you.

Qualifications

• 2+ years of experience in adjudicating outpatient claims in HMO/Managed Care.
• Proficient in Medicare and Medi-Cal claims processing.

Responsibilities

• Process outpatient professional and institutional claims accurately.
• Ensure compliance with IEHP’s Quality Program goals.

Skills

ICD-9 Coding

CPT Coding

Claims Processing

Communication Skills

Organizational Skills

Computer Literacy

Education

High School Diploma or GED

Tools

Windows Applications

Job description

This position is a temporary role facilitated through one of our contracted agencies and is not a direct employment opportunity with IEHP. The contracted agency offers an assignment length of up to six months, during which the candidate will provide support for IEHP.

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to anauthentic experience!

Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Education & Requirements

• Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting
• Processing of Medicare, Medi-Cal, or Commercial claims required
• Proficient in rate applications for Medi-Cal and/or Medicare pricers
• High school diploma or GED required

Key Qualifications

• ICD-9 and CPT coding and general practices of claims processing
• Prefer knowledge of capitated managed care environment
• Microcomputer skills, proficiency in Windows applications preferred
• Excellent communication and interpersonal skills, strong organizational skills
• Professional demeanor
• Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home
• 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

Start your journey towards a thriving future with IEHP and apply TODAY!