What are the responsibilities and job description for the Claims Examiner - Talent Pipeline position at CenCal Health?
Job Details
Description
While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.
About This Opportunity:
CenCal Health is continuously seeking top talent for Claims Examiners. While this is not an immediate opening, we actively review applications for future hiring needs. If you are interested in being considered for upcoming opportunities, we encourage you to apply!
Why Join Our Talent Pipeline?
- Be among the first to be considered when new positions become available.
- Stay connected with our Talent Acquisition team for future opportunities.
- Explore potential career paths with CenCal Health.
Who Should Apply?
We welcome applications from individuals with experience in the healthcare field, particularly in claims. If a position matching your background and interest opens, our team will reach out to discuss the next steps.
Next Steps:
By applying to this posting, your resume will be added to our talent pipeline. Our recruiters will contact you if your qualifications align with an available role. Please continue to check our Careers page for active job postings at https://www.cencalhealth.org/explore-cencal-health/careers/.
SALARY RANGE: $23.30 - $32.62 per hour
Job Summary
This position is responsible for: researching and resolving all pended claims as well the review of claim denials that require manual review in a timely manner; determining whether a claim should be paid (in accordance with the policies and procedures) and maintaining correspondence for document procedure /medical/CPT/ HCFA codes; assuring all regulatory guidelines are being followed.
Duties and Responsibilities
- Review, price and release claims associated with the assigned claim types (paper and electronic)
- Review Manual Review reports that suspend for review on all CenCal Health programs
- Review denied claims from the Master Denial reports for all CenCal Health programs
- Review/audit claims from specific specialized reports (ER/FP, MH etc.)
- Analyze current processes and work with Supervisor to automate or improve quality where fit
- Assist with ideas for creation of SCF (System Change Forms) when applicable
- Keep up to date on all CenCal Health policies and provide materials for improvement projects within Department
- Assure all regulatory guidelines are being followed and monitored
- Maintain daily activity log
- Assist with the processing of claims
- Audit and report all billing & error trends found during the course of review and data entry;
- Maintain processes and timelines required by AB1455 Claims Settlement Practices and DHCS Regulations
- Other duties and projects as assigned
Qualifications
Skills/Knowledge/Abilities
- Knowledge of the Medi-Cal program
- Prior experience in high volume production environment
- Good oral and written communication skills
- Attention to detail
- Medical terminology and/or coding experience is highly desirable
Education and Experience
Required:
- High school diploma or equivalent
- Previous experience as a claims examiner
Salary : $23 - $33
