Claims Processor

Location: Rancho Cucamonga, California

Schedule: Monday through Friday 8a-5p 40 hours/week

Pay: $24/hour

Requirements: two (2) years of experience

Job Type: 6 month contract, High school diploma or GED

Summary: 

1. Responsible for non-delegated provider claims verification and adjudication.


2. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications.


3. Meet Regulatory Compliance Regulations on turnaround times and claim payments.


4. Read and interpret Medi-Cal/Medicare Fee Schedules.


5. Must be able to make a sound determination if claim is eligible for payment or denial.


6. Interface with other departments, when necessary, regarding claims issues.


7. Participate in Claims Department staff meetings, and other activities as needed.


8. Responsible for meeting the performance measurement standards for productivity and accuracy.


9. Any other duties as required to ensure the operations are successful.

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