Randstad Claims Processor in Irvine, California

Claims Processor

job details:

  • location:Irvine, CA

  • salary:$23 per hour

  • date posted:Tuesday, March 13, 2018

  • job type:Temp to Perm

  • industry:Administrative and Support Services

  • reference:S_623486

job description

Duration: 3/26/18-6/25/18 (Temp to Hire)

Hours: M-F 8am-4:30pm

Pay: $23.00/hr

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.

Specific Duties:

  1. 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.

  2. Researches claim processing problems and errors to determine their origin and appropriate resolution. Prepare reports and summarizes observations for management summarizing observations and recommendations.

  3. 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.

  4. 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.

  5. Maintains a minimum audit accuracy rate.

Working hours: 8:00A to 4:30P


Must have qualifications/experience:

  1. Minimum 2+ years Medical Claims experience is required.

  2. Experience working with Medicare / Medicaid / HMO

  3. 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.

Preferred qualifications:

  1. Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms and CPT Coding.

  2. Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages.

  3. Ability to apply common sense understanding to carry out instructions furnished in written, oral, and diagram form.

  4. Ability to deal with problems involving several concrete variables in standardized situations.

  5. Detail oriented.

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.