Claims Processor III

IEHP•California, MD

42d•$26 - $33•Remote

About The Position

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, and claim adjustments 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.

Requirements

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
ICD-9 and CPT coding and general practices of claims processing
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