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Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, Tricare, etc), and how these payors process claims.
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Department(s): Grievance & Appeals Resolution Services (GARS)Reports to: Manager, Grievance & AppealsSalary: $24.52 - $31.04 Duration: up to 6 months Job Summary The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
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Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines. Claims Examiner I is responsible for reviewing and processing medical, dental, vision and electronic claims in accordance with state, federal and health plan regulatory requirements, department guidelines, as well as meet established quality and production performance benchmarks to include research and review of applicable documentation.
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Requires broad training in fields such as business administration, accountancy, sales, finance/economics, computer sciences or similar vocations generally obtained through completion of a four year bachelor’s degree or equivalent work experience; Experience in retail pharmacy support, including knowledge in dealing with PBM claims processing, payment processing and reconciliation, preferred.
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This position is expected to be highly collaborative by working closely with other departments such as the Claims, Intake, and Social Work teams to remedy any eligibility/enrollment issues. Initiate and maintain proper follow-ups with DHCS and CMS to ensure timely processing and completion of all mandated applications and accompanying documentation Maintain knowledge of eligibility and enrollment requirements for individuals participating in the Program of All-inclusive Care for the Elderly (PACE), including but not limited to out-of-area issues, Share of Costs (SOC), Primary Aid Codes, and excluded benefits.
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Train on claims processing procedures and systems. When you join the Auto Club as a Claims Representative, you're bringing your expertise to a best-in-class organization that is focused on delivering quality service to our members.
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The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers.
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Under the direction of the Senior Supervisor, Customer Service, this position is responsible for responding to general customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.
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Processing disability claims of minimal disability duration under close supervision. Industry Advancement Program | Workers Compensation Claims Representative Trainee | Orange, CA (In-Office.
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As a Medical Biller, you will be responsible for accurately and efficiently processing medical billing claims, answer questions related to billing, collecting necessary information or documentation from clients, record billing information, resolving billing issues, and ensuring timely reimbursement from insurance companies.
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Analyzes and resolves specific billing edits/errors that are delaying claims for processing in EPIC. Applicant has a general understanding of outpatient Medicare reimbursement methodologies, including CPT/HCPC and UB Revenue Coding.
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Familiarity with insurance claims processing and requirements. Communicate with insurance companies regarding client’s property damage claims. As a Property Damage Specialist, you'll be responsible for managing and resolving property damage claims efficiently.
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The Insurance Collections Coordinator will assist the Insurance Collections team with accurate, detailed, and thorough medical billing processes, while utilizing their Collections billing knowledge to ensure that claims are processing and paying accurately.
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Responsible for researching denials and rejections, settling payer issues, documenting account activity, posting adjustments, and demonstrating proficiency with the XIFIN billing system to ensure all functionalities are utilized for the most efficient processing and adjudication of claims.
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The Vertex Companies, LLC (VERTEX) is a leading multidisciplinary engineering and consulting firm that provides forensic consulting, engineering design, construction management, claims & dispute resolution, and environmental solutions to insurance carriers, sureties, law firms, real estate owners, property managers, public agencies, and commercial clients.
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claims processing jobs in Santa Ana, CA
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