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IEHP · 3 days ago

Claims Specialist - Covered CA

Rancho Cucamonga, CA

Full-time

Hybrid

Mid Level

$25.90/hr - $33.02/hr

3+ years exp

Inland Empire Health Plan (IEHP) is a not-for-profit public health plan supporting over 1.5 million residents in Riverside and San Bernardino Counties. The CCA Claims Specialist is responsible for managing and investigating complex healthcare claims, collaborating with stakeholders, and ensuring accuracy in claims processing.

Health CareHealth DiagnosticsHospital

Comp. & Benefits

No H1B

Responsibilities

Analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors

Adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues

Collaborating with internal stakeholders

Assisting with claim audits (internal and regulatory)

Utilizing strong analytical skills and independent judgement skills to make effective and accurate decisions

Responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly

Qualification

Claims processingICD-9/ICD-10 codingCPT codingManaged care experienceCMS/DMHC regulationsAffordable Care ActAnalytical skillsIndependent judgementCollaboration

Required

Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims

High school diploma or GED required

ICD-9/ ICD-10 and CPT coding and general practices of claims processing

CMS/DMHC and Affordable Care Act regulations and guidelines

Commercial line of business specifically Covered California/Exchange

Preferred

Experience in a managed care environment helpful

Associate's degree from an accredited institution preferred

Commercial, Exchange, and Medicare preferred

Benefits

Telecommute schedule

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Life, short-term, and long-term disability options

Career advancement opportunities and professional development

Wellness programs that promote a healthy work-life balance

Flexible Spending Account – Health Care/Childcare

CalPERS retirement

457(b) option with a contribution match

Paid life insurance for employees

Pet care insurance

Company

IEHP

Glassdoor3.8

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®.

Founded in 1995

Rancho Cucamonga, California, USA

1001-5000 employees