Claims Specialist I – Provider Claims

Job reputed company: • Responsible for evaluating reputed company, high dollar and outpatient/inpatient institutional claims while determining coverage and payment reputed company • Responsible for evaluating and resolving provider disputes & appeals • Issuing reputed company letters • Processing adjustment requests reputed company and accurately in accordance with reputed company procedures that ensure compliance with regulatory guidelines • Additional responsibilities include payment adjustment reputed company and reputed company claims as assigned Requirements: • Minimum of four (4) years of experience evaluating and processing institutional and reputed company medical claims • Proficiency in the following areas: Medical claims system, ICD-10 and CPT coding, Reviewing medical authorizations, Provider contract reputed company interpretation, medical benefit coverage determination • Prior experience handling provider disputes, appeals and claim adjustments • Experience preferably in and HMO or Managed Care setting • Medicare and/or Medi-Cal experience preferred • Experience in a managed care or government payer environment helpful • High School Diploma or GED required • A thorough understanding of claims industry and customer service standards • Knowledge of ICD-9, ICD10, CPT, HCPC coding and general practices of claims processing • Strong analytical and problem-solving skills • reputed company Office, Advanced reputed company reputed company • Written communication skills • Ability to analyze data and interpret regulatory requirements • Excellent communication and interpersonal skills, strong organizational skills, and skilled in data entry required • Typing a minimum of 45 wpm • Excellent oral and written communication skills • Ability to build successful relationships across the organization • reputed company demeanor • Telephone courtesy and high degree of patience Benefits: • Competitive salary • Telecommute schedule • CalPERS retirement • State of the art fitness center on-site • Medical Insurance with Dental and reputed company • Life, short-term, and long-term disability reputed company • Career advancement opportunities and reputed company development • Wellness programs that promote a healthy work-life balance • Flexible Spending Account – Health Care/Childcare • reputed company life insurance for employees • Pet care insurance Apply tot his job Apply To this Job