Claims Processor
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Job Location:
Rancho Cordova, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
4 hours ago
Vacancies:
1 Vacancy
Job Summary
Where Youll Work
Dignity Health Medical Foundation established in 1993 is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California Arizona and Nevada. Today Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled qualities that are vital to maintaining excellence in care and service.
Job Summary and Responsibilities
This position is responsible for following written criteria policies and procedures in reviewing and processing claims received from Out of Group providers to determine if such claims are appropriate for position also considers eligibility benefits authorizations coding compliance contracted payment terms and health plan contracts to decide the disposition of a claim. The contracts can change annually and the examiner must be able to apply the correct terms to the the claim is not appropriate for payment the examiner is responsible for making sure that the denial is done correctly in the system so that the letter will print are internal external and governmental timeliness standards that consistently need to be position has the freedom to pay or deny medical services by using the policy guidelines of the department and to process sensitive and confidential the claim & information received does not meet our departmentpolicy guidelines this position must refer the claim and documentation to UM department as position could have contact with Eligibility Member Services UM providers the Health Plans and any applicable there are production and quality standards that must be position will have responsibility for working independently on assigned tasks and activities based on established policies and procedures.
Job Requirements
Minimum Qualifications:
- High School Graduate or GED
- One year experience in a medical insurance environment.
- Keyboarding skills and the ability to utilize computer equipment and software are required as is experience with other types of standard office equipment.
- Forty-five (45) wpm and 10 key by touch
Preferred Qualifications:
- Familiarity with an electronic practice management system
- Medical terminology
Key Skills
- Loan Processing
- Typing
- Data Entry
- Customer Service
- Organizational skills
- Basic Math
- Computer Skills
- Fraud
- Microsoft Outlook
- 10 Key Calculator
- Fair Housing Regulations
- Food Processing
About Company
Dignity Health provides compassionate, high-quality, affordable health care services throughout Arizona, California and Nevada. Schedule an appointment today!
