Randstad Claims Processor in Irvine, California
salary:$23 per hour
date posted:Tuesday, March 13, 2018
job type:Temp to Perm
industry:Administrative and Support Services
Duration: 3/26/18-6/25/18 (Temp to Hire)
Hours: M-F 8am-4:30pm
This position is responsible for reviewing all processed claims prior to payment release, and respond to all potential health plan capitation deduction report for Health Maintenance Organization (HMO) Enrollees for Medicare and HMO Enrollees.Please Complete.
Performs routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration with ability to extract and audit exception audit reports.
Researches claim processing problems and errors to determine their origin and appropriate resolution. Prepare reports and summarizes observations for management summarizing observations and recommendations.
Participates in communication with Business Operations management regarding trends in order to improve claims processing accuracy and documented business rules for incorporation into training programs, policies and procedures.
Identifies and escalates issues related to instructional material that is inaccurate, unclear or contains gaps. Provides recommendations for correction of this material. Confers with management to assess training needs in response to changes in policies, procedures, regulations, and technologies.
Maintains a minimum audit accuracy rate.
Working hours: 8:00A to 4:30P
Must have qualifications/experience:
Minimum 2+ years Medical Claims experience is required.
Experience working with Medicare / Medicaid / HMO
Knowledge of healthcare regulations and guidelines including CMS and MHC as pertains to AB1455. Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms, and CPT Coding.
Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms and CPT Coding.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, and diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
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