Claims Examiner I - Partnership Healthplan of California

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Located in Redding, CA

Salary: $26.00 per hour

You MUST have previous experience in medical billing, coding and/or claims to qualify for this position.

PLEASE READ THE JOB DESCRIPTION CAREFULLY AND, IF YOU DO NOT QUALIFY, PLEASE SEND YOUR RESUME TO JOBS.REDDINGCA@EXPRESSPROS.COM FOR CONSIDERATION FOR OTHER POSITIONS.

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About Express:

Express Employment Professionals, named ClearlyRated Best of Staffing® Client and Talent Awards winner for the past 7 years, is hiring for a local client company in Shasta County.  We help people in our community find work every day.  Express Employment Professionals in Redding wants to make a difference locally and across North America.  With more than 800 locations across the U.S., Canada, and South Africa, we are on a mission to put a million people to work annually.

About the Client:

Partnership Healthplan of California is a non-profit health care organization that administers Medi-Cal benefits in 24 Northern California counties.

About the Position:

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing.  Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters.  Routes and tracks claims requiring review by other staff and departments, and processes when possible.

Job Description/ Responsibilities:

-Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report. 
-Routes claims to appropriate PHC departments and internal staff for additional review. 
-Follows up and completes claims once response to request has been received. 
-Follows established PHC policies and procedures, PHC Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. 
-Generates claims correspondence as needed. 
-Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor. 
-Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame. 
-Supports Claims Department’s needs for resolving all pended claim types. 
-Participates in special projects and assignments as required. 
-Other duties as assigned. 

Qualifications:

-Must excel in a fast paced environment. 
-MUST have previous medical claims experience.
-High school diploma or equivalent; prior experience examining claims in an automated environment; or equivalent combination of education and experience.
-Effective written and oral communication skills. Good organization skills. 
-Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. 
-Ability to stay focused on repetitive work and meet production and quality standards. 
-Ability to accurately complete tasks within established timelines. 
-Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor. 
-When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.
-Provide the highest possible level of service to clients; 
-Promote teamwork and cooperative effort among employees; 
-Maintain safe practices; and 
-Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

Shift:

Monday-Friday 8 am to 5 pm

Compensation:

$26.00 per hour

About You:

You are attentive, responsive, and can take control of situations. 
You are personable, determined, and driven to make a difference. You can see beyond a problem, respond to situations in crafty ways, and put a positive and professional spin on any situation.
Multitasking and professionalism are natural habits. 
You thrive on succeeding, overcoming challenges, and have an exceptional work ethic.
Friends and co-workers describe you as a highly organized and productive person.
You are a team player and an individual performer who can quickly connect with others inside and outside of the company.
You naturally possess a “can get it done attitude” even when the odds are not in your favor.
You are very organized and disciplined and can effectively manage multiple conflicting priorities and deadlines in a rapidly changing environment.
You are reliable and are always looking for what to do next.
You are at least 18 years of age.

Pre-employment screenings if required by the client

Express Employment Professionals – Redding
2697 Victor Avenue
Redding, CA  96002
530-221-7044 call or text
Jobs.ReddingCA@ExpressPros.com

Express Employment Professionals is an equal opportunity Employer.  

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