[Hiring] Claims Processor III @Inland Empire Health Plan

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level III must have experience in processing complex professional and institutional claims. This includes, but is not limited to: • Inpatient high dollar claim types • COB • Home health • Transplant • Dialysis • Oncology/chemo • Hospital exclusions • Claim adjustments 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. Qualifications • Minimum of three (3) years of experience processing inpatient and outpatient professional and 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 Requirements • 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 • All IEHP positions approved for telecommute 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 Benefits • Competitive salary • Telecommute schedule • State of the art fitness center on-site • Medical Insurance with Dental and Vision • Life, short-term, and long-term disability options • Career advancement opportunities and professional development • Wellness programs that promote a healthy work-life balance • Flexible Spending Account – Health Care/Childcare • CalPERS retirement • 457(b) option with a contribution match • Paid life insurance for employees • Pet care insurance Key Responsibilities • Adjudicate complex professional and institutional inpatient/outpatient claims. • Meet Regulatory Compliance Regulations on turnaround times and claim payments. • Assist with training and mentoring of new Team Members. • Must be able to make a sound determination if claim is eligible for payment or denial. • Complete claim using multiple source documents to verify data and/or use additional information to adjudicate claim. • Assist with the testing of new claim processing procedures or projects. • Read and interpret Medi-Cal/Medicare Fee Schedules. • Responsible for meeting performance measurement standards for productivity and accuracy. • Adjudication of claim adjustments. • Review and correct claims involving data integrity issues. • Interface with other IEHP Departments, when necessary, regarding claims issues. • Participate in Claims Department Team Meetings, and other activities as needed. • Any other duties as required to ensure the Health Plan operations are successful. Work Model Location Telecommute (All IEHP positions approved for telecommute 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) Pay Range USD $25.90 - USD $33.02 /Hr. Apply tot his job