Claims Processor (Full Remote) PST Time Zone only

Job Description: Remote Claims Processor

Position: Remote Claims Processor
Pay Rate: $20/hr
Schedule:

• Training: 8:30 AM – 5:00 PM PST
• Post-Training: 7:00 AM – 4:00 PM PST

Key Responsibilities:

1. Meet or exceed claims accuracy standard of 95% or greater.
2. Maintain overpayment and underpayment standard of 98% or greater.
3. Meet or exceed the department production quota of 30 claims per hour.
4. Adjudicate and process PCP claims, applying all claims policies, contracts, practices, and ensuring compliance with industry regulations and guidelines.
5. Work independently to resolve claims and make claims resolution decisions with limited supervision.
6. Confirm eligibility for claims billed and the date of service.
7. Comply with claims timeliness guidelines for PCP providers, ensuring a turnaround time (TAT) of no greater than 90 days.
8. Adhere to all company and department policies and procedures.

Day-to-Day Responsibilities:

1. Resolve claims issues identified through processing errors and recommend improvements to avoid future errors.
2. Process and adjudicate claims in the order they are received (First In, First Out).
3. Address grievances and complaints received through the Claims Customer Service Call Center.
4. Provide prompt and accurate responses to claims-related questions from supervisors and management.
5. Identify overpayments or underpayments during reviews or history searches, report them per department protocol, and follow up as needed.
6. Be able to sit for lengthy periods, up to three hours at a time.
7. Be able to lift a maximum of 10 pounds.
8. Perform any additional tasks or assignments as required by the Claims Supervisory Team and Upper Management.

Required Skills:

1. Knowledge of CPT and ICD-9 codes, and medical terminology.
2. High school diploma or equivalent.
3. Excellent verbal and written communication skills.
4. Strong organizational skills and interpersonal skills.

Required Experience:

• 3-5 years of relevant experience.

Additional Requirements:

• Must work in PST timezone.

Opportunity: This is a temp-to-perm position with the potential to be hired permanently after 13 weeks based on performance. Pay: $20.00 per hour

Benefits:

• Various levels of benefit plans available, including health, dental, and vision, offered by the agency at an additional cost.
• Temp-to-perm opportunity after 13 weeks.