an accurate and expedient manner. Major Functions (Duties and Responsibilities) 1. Adjudicates complex professional and institutional claims. 2. Assist with training and mentoring of new team members. 3. Assist with the testing of new claim processing procedures or projects.
4. Responsible for meeting performance measurement standards for productivity and accuracy. 5. Adjudication of claim adjustments. 6. Review and correct claims involving data integrity issues. 7. Interface with other IEHP Departments, when necessary, regarding claims issues. 8. Participate in Claims Department Team Meetings, and other activities as needed. Major Functions (Duties and Responsibilities) Cont Supervisory
Responsibilities Leading: Self Experience Qualifications Three (3) years experience in adjudicating medical claims. Preferred Experience Experience in adjudicating medical claims: professional and institutional preferably in and HMO or Managed Care setting.
Medicare/Medi-Cal experience preferred. Education Qualifications High School Diploma or GED required. Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement ICD-9 and CPT coding and general practices of claims processing. Skills Requirement Microcomputer skills, proficiency in Windows applications preferred. Eexcellent communication and interpersonal skills, strong organizational
skills required. Abilities Requirement Professional demeanor.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence. Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership. Work Model Location Telecommute Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Regular and reliable attendance - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY Near Visual Acuity - FREQUENTLY A reasonable salary expectation is between $48,110.40 and $59,425.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
and adjudication. 2. Adjudicate all professional and outpatient facility claims including COB, denials, and reduction in service notifications 3. Interface with other IEHP Departments, when necessary, regarding claims issues. 4. Participate in Claims Department staff meetings, and other activities as needed 5.
Responsible for meeting the performance measurement standards for productivity and accuracy for one specific type of claim form, professional (HCFA) or institutional (UB. ) Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading: Self Experience Qualifications Two (2) years experience in examining and processing medical claims; professional or institutional.
Preferred Experience Medicare/Medi-Cal experience preferred. Claim adjustments, provider appeals and/or disputes preferred. Education Qualifications High school diploma or GED required.
Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement ICD-9 and CPT coding and general practices of claims processing. Prefer knowledge of capitated managed care environment. Skills Requirement Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills, strong organizational skills. Abilities Requirement Professional demeanor. Commitment to Team Culture The IEHP Team environment requires
a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence. Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Telecommute Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $45,884.80 and $55,993.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
