Specialist, Claims - Long Beach, United States - Molina Healthcare

Molina Healthcare

Verified Company

Long Beach, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Description

Job Summary

Thorough knowledge of processing professional, outpatient facility, and inpatient facility claims for Medicare, Medicaid, and Marketplace plans. Assists Molina departments with reviewing and conducting analysis of claims to ensure regulatory requirements are appropriately applied. Clearly documents claims research results and root cause of processing errors. Recommends remediation plan and assists with monitoring of claims reprocessing. Supports and contributes towards the summary and presentation of findings. Responsible for ensuring the claims research is completed accurately by the established timelines.

Job Duties

Uses claims knowledge to conducts research and analysis for assigned claims projects

Communicates clear in-depth analysis of claims research results and recommended remediations

Engages appropriate departments to deliver accurate analysis

Requests appropriate claims data to minimize manual claims research

Research claims using standard principles and applicable state specific policies and regulations

Helps to improve overall claims performance to ensure claims are processed accurately and timely

Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance

Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance

Manages work assignments to ensure accurate completion by the established timelines

Job Qualifications

REQUIRED EDUCATION:

High School Degree or GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

3-5 years medical claims processing experience

Ability to work with Excel

PREFERRED EDUCATION:

Associate's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

1-3 years claims analysis

5-7 years medical claims processing experience

Proficient in Excel

PHYSICAL DEMANDS:

Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range:
$ $31.97 / HOURLY