Data Entry Tech (Population Health Management)
This position is responsible for the review of the claims data file, as well as following regulatory and internal guidelines in conjunction with company policies and procedures as they apply to claims receipt and adjudication. The incumbent will data enter claim forms, audit and validate the accuracy of the claims data lift from the scanning vendor and generate and review daily claims reports.
- Reviews claim form data according to guidelines, ensures accurate and validity of the data.
- Reconciles daily scanned claim volume report from vendor, reports any discrepancy to
- Reviews and researches claims data for correct provider and member eligibility.
- Creates and maintains reporting as needed for management, reviews daily claims reports; updates data in the claims adjudicating system and in a shared database between the Claims department and Provider Enrollment team of providers that are not actively registered with the company.
- Handles claims mail; triages to appropriate persons and sends misrouted claims to the appropriate group within 10 (ten) business days.
- Alerts supervisor of any issues that impact production and quality.
- Monitors claims based on compliance regulation and timeframes.
- Manual data entry Enters of claim data manually with appropriate information as required.
- Reviews rejected claim files received from vendor to determine appropriate course of action.
- Assists Supervisor with monitoring claim turnaround time.
- Ensures all Protected Healthcare Information (PHI) is locked at the end of the day.
- Other duties as assigned by management.
Possess the Ability To:
- Use 10-key by touch.
- Data entry using common techniques.
- Analyze files and determine appropriate course of action.
- Work independently and as part of a team.
- Develop and maintain effective working relationships with all levels of staff.
- Maintain organized files and be detail oriented.
- Communicate clearly and concisely, both verbally and in writing.
- Utilize computer and appropriate software (i.e. MS Office: Outlook, Excel, Access, and Word) and interact as needed with company Claims Processing Systems.
Experience & Education
- High School graduate or equivalent required.
- 1 year of data entry experience within managed care and/or a healthcare claims environment required.
- Medical claims experience preferred.
- Different types of Medi-Cal claim forms; CMS1500, UB04, PM160, 25-1.
- Standard medical terminology, CPT-4, HCPC, revenue codes, and ICD-10.