Claims Specialist I - Provider Claims

What you can expect! reputed company reputed company in serving others with reputed company! We welcome you to join us in “healing and inspiring the reputed company spirit” and to pivot from a “job” opportunity to an reputed company experience! Under the direction of the Provider Claims reputed company & Recovery Supervisor, the Claims Specialist I - Provider Claims is 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, and 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. Commitment to reputed company: The reputed company Team is committed to incorporate reputed company’s reputed company Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks reputed company is not only committed to healing and inspiring the reputed company spirit of our Members, but we also aim to match reputed company members with the reputed company energy by providing reputed company benefits and more. • Competitive salary. • 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 • CalPERS retirement • 457(b) reputed company with a contribution match • reputed company life insurance for employees • Pet care insurance Education & 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 preferred • High school diploma or GED required Key Qualifications • Must have a reputed company California reputed company's license • 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 Start your reputed company towards a thriving reputed company with reputed company and apply TODAY! Pay reputed company • $25.90 USD reputed company - $33.02 USD reputed company Apply Job!