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* Adjudication of encounter, PCP and Pediatric claim from beginning to end.
* Knowledge of some ICD-9, ICD-10, CPT, and HCPC codes and annually update
* Apply all claims policies, contracts, practices and keep in compliance with industry regulations and guidelines
* Confirm eligibility for claim billed and date of service.
* Match and link authorization for required claim
* Comply with claims timeliness guidelines: commercial 45 working days; Medi-Cal 30 calendar days; Medicare non-contracted 30 calendar days and Medicare contracted 60 calendar days.
* Proficient in and performs the application of "Coordination of Benefits".
* Knowledge of Federal and State requirements in claim processing.
* Identify any overpayment underpayment in a review and or history search. Follow department protocol for reporting and following up.
* Recognize claim correspondences from multiple IPAs.
* Recognize the difference between Shared Risk and Full Risk claims.
* Support the Claims Department as business needs require.
* Maintains the strictest confidentiality at all times.
* Complies with all Company and Department Policies and Procedures.
* All other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable with disabilities to perform the essential functions.
Work is performed in an office environment. Must be able to tolerate sitting for long periods of time. Must be able to deal with busy, high pace office. Pace of work may be rapid and intense especially when faced with proposal deadlines.
The noise level in the work environment is usually moderate. May drive to various locations and will be subject to weather and road conditions.
Attendance at employer worksite is an essential job requirement.
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email accommodation@aerotek .com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
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