Claims Processor I

1. Responsible for analyzing and processing claims EDI error queues prior to claim adjudication, correcting claim information and data integrity.
2. Processes professional claims as assigned by Supervisor or Manager based upon the team member's knowledge, experience and billing and coding training.
3. Prepare outgoing correspondence for the Claims Department including misdirected claims, additional information requests, and other mailings as needed.
4. Interface with other Departments, when necessary, regarding claims issues.
5. Participate in Claims Department staff meetings, and other activities as needed
6. Responsible for meeting performance measurement standards for productivity and accuracy.
7. Any other duties as required to ensure the company operations are successful.
8. Ensure the privacy and security of PHI (Protected Health Information) as outlined in Company policies and procedures relating to HIPAA compliance.

• Two (2) years of experience as a Data Entry Processor
  • Data Entry Processor experience preferably in an HMO or Managed Care setting. Medicare/Medi-Cal experience preferred
• High school degree or GED required

Key Qualifications

• Must have a valid California Driver's license
• ICD-10 and CPT coding and general practices of claims processing preferred but not required. Prefer knowledge of capitated managed care environment
• Strong analytical and problem-solving skills. Microsoft Office, Advanced Microsoft Excel. Excellent oral and written communication skills. Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills.
• Ability to build successful relationships across the organization. Professional demeanor and strong organizational skills.