Claims Processor II - Outpatient Professional & Facility 25-00430Alura Workforce Solutions • Rancho Cucamonga, CA
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Claims Processor II - Outpatient Professional & Facility 25-00430
Alura Workforce Solutions • Rancho Cucamonga, CA
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- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionICD-9 and CPT coding and general practices of claims processing Prefer knowledge of capitated managed care environment Microcomputer skills and 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 All remote / telecommute positions may periodically be required to report to the main campus for mandatory in-person meetings or for other business needs as determined by leadership. High school diploma or GED required
POSITION
Claims Processor II
(Outpatient Professional & Facility Claims)
Position Type : Full-Time / Contract
Schedule : M-F, 8 : 00 am - 4 : 30 pm; Remote
Assignment Length : Up to 6-Months
DESCRIPTION
Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional (CMS-1500) and facility (UB-04) claims. This includes, but is not limited to, lab, radiology, ambulance, behavioral health, outpatient COB, dialysis, oncology / chemo, hospital exclusions, etc., in an accurate and expedient manner.
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
- Experience calculating or verifying reimbursement rates for Medi-Cal and / or Medicare
KEY QUALIFICATIONS
Education
INDH
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Processor • Rancho Cucamonga, CA
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