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Partnership HealthPlan of California · 1 day ago

Claims Customer Service Representative I

Sonoma County, CA

Full-time

Onsite

Entry Level

$28.94/hr - $34/hr

1+ years exp

Partnership HealthPlan of California is seeking a Claims Customer Service Representative I to research and resolve provider inquiries and process claims. The role involves responding to provider inquiries, ensuring compliance with established policies, and participating in meetings to improve claims processing efficiency.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Responds to provider telephone inquiries, researches policy issues, and analyzes EOP's and claim history, recommends resolution to the issues, implements resolution once approved

Researches and communicates outcome to providers of CIF's, claim tracers, and general claim correspondence within established time frames

Follows established Partnership policies and procedures, Partnership claims operating instruction memorandums, EDS provider manual guidelines, and Title 22 regulations when resolving claims and claim issues

Participates in provider meetings to resolve claim issues

Recognizes and gives feedback to management on procedure changes that would result in more efficient operations

Records daily production statistics and related activities on appropriate reports; turns all logs and reports in to Claims Customer Service Supervisor

Meets established production and call performance metrics as determined

Participates in special projects and assignments as required

Participates in resolution of CIFs as required

Other duties as assigned

Qualification

CPT codingHCPC codingICD-10 codingMedical terminologyClaims processing experienceJudgmentTactDiplomacyWritten communicationOral communicationOrganizational skills

Required

High school diploma or equivalent

One (1) year of prior claims processing experience in an automated claim environment

Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding

Ability to access coding reference guides for accurate information

Typing speed 30 wpm

Proficient use of 10-key calculator

Excellent written and oral communication skills

Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy

Good organizational skills

Ability to accurately complete tasks within established time frames

Ability to use a computer keyboard

Ability to move, carry, or lift objects of varying size weighing up to 25 lbs

Preferred

One (1) year of prior claims processing experience in an automated claim environment preferred

Knowledge of medical terminology preferred

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees