Processor jobs at FirstHealth of the Carolinas

BroadPath is excited to announce that we are hiring **Work-From-Home Claims Processors!** In this role, you'll play a key part in ensuring the accurate and timely entry, review, and resolution of simple to moderately complex Medicaid claims. You'll follow established guidelines, procedures, and client policies while helping deliver a smooth, efficient claims experience. **Compensation Highlights:** + Base Pay: $18.00 per hour + Pay Frequency **:** Weekly **Schedule Highlights:** + Training Schedule: 1 week, Monday-Friday, 8:00 AM - 5:00 PM AZ + Production Schedule: Monday-Friday, 8:00 AM - 5:00 PM AZ, no weekends! **Responsibilities** + Process incoming Medicaid claims in accordance with all applicable policies, procedures, and guidelines + Verify that all required data fields are present and that necessary medical records are included and reviewed when required + Refer claims for medical claim review when appropriate + Work effectively in a virtual, work-from-home environment while accurately processing claims **Qualifications** + 2+ years of recent health insurance claims processing experience + Ability to maintain balanced performance across production and quality + Ability to uphold confidentiality and present a professional business image + Positive attitude, strong reliability, and the ability to work independently from home while collaborating well with a team **Preferred** + Prior experience processing Medicaid claims highly preferred but not required + Prior work-from-home experience + IDX system experience + AHCCCS system experience + Experience with Citrix, Siebel, HPIS, DataNet, Excel, and SharePoint **Diversity Statement** _At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!_ _Equal Employment Opportunity/Disability/Veterans_ _If you need accommodation due to a disability, please email us at_ _*****************_ _. This information will be held in confidence and used only to determine an appropriate accommodation for the application process._ _BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law._ _Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location._

Are you a current UMass Memorial Health caregiver? Apply now through Workday. Exemption Status: Non-Exempt Hiring Range: $20.94 - $33.59 Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations. Schedule Details: Scheduled Hours: Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 99940 - 5416 Payment Variance and Contracts Union: SHARE (State Healthcare and Research Employees) This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Responsible for processing payment discrepancies (under/overpayments). Reviews, analyzes and initiates appropriate action for discrepancy resolution. Responsible for processing payment discrepancies (under/overpayments). Reviews, analyzes and initiates appropriate action for discrepancy resolution. Major Responsibilities: Prioritizes standards and guidelines to perform payment variance follow up utilizing assigned work queue. Analyzes and researches overpayments and underpayments with payers. Determines and executes the best approach for resolution. Validates payment discrepancies using Hospital Billing Revenue Cycle management system calculations. Identifies and isolates payment variance trends and discrepancies, escalates as appropriate. Corresponds with third party payers, hospital departments, and patients to obtain information required for payment variance resolution. Clearly documents all actions taken during the resolution process. Applies reimbursement concepts while researching and triaging payment variance. Position Qualifications: License/Certification/Education: Required: High School diploma Experience/Skills: Required: Two or more years of experience in health care billing functions. Knowledge and experience with health care revenue cycle systems and billing tools. Proven track record of successful performance and goal achievement. Ability to perform assigned tasks efficiently and in timely manner. Ability to work collaboratively and effectively with people. Exceptional communication and interpersonal skills. Strong analytical skills. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day. As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law. If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at ***********************************. We will make every effort to respond to your request for disability assistance as soon as possible.

Responsible for portaling and scanning paper documents into electronic medical records for upcoming patient appointments. Responsible for reviewing patient records to add comorbid conditions to patient problem list. Responsible for electronically processing patient health information. Clinical knowledge and understanding of medical terminology to correctly identify health information in medical charts. Principal Duties & Responsibilities: Example of Essential Duties: 1) Portal patient records from outside health systems 2) Review patient records for comorbid conditions to add to patient problem list 3) Accurately scan medical records into EHR system 4) Fax records to physician offices or Hospitals 5) Answer phones 6) Ability to identify patient medical record documents by name. Other Essential Duties May Include (but are not limited to): * Handle requests for release of patient medical information according to HIPAA rules and copy service contract. * Other duties as assigned. Knowledge, Skills & Abilities Required: Required: * Knowledge of comorbid conditions * Clinical knowledge and ability to read and understand medical charts * Ability to accurately identify medical record documentation by name for electronic filing. * Excellent customer relations and phone protocol * Excellent organizational skills required. * Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame. * Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed. * Demonstrates adaptability to expanded roles. * Adheres to all clinic policies and procedures. Education: * HS diploma or GED Preferred: * Previous experience in a medical office, in medical coding, or in medical records.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary 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 Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Prefer knowledge of capitated managed care environment Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $23.98 - USD $30.57 /Hr.

Payment Specialist - (2500039L) Description The Payment Posting Specialist is responsible for accurately and efficiently posting payments and adjustments to patient accounts in a healthcare billing system. This role ensures that all payments from insurance carriers and patients are posted in a timely manner, discrepancies are investigated, and billing records remain up to date and accurate. Qualifications Required: High School Diploma or GEDWork Experience and Additional InformationTwo (2) years of experience in payment posting within a medical billing or Revenue Cycle Management environment. Strong knowledge of reading and interpreting EOB's, ERAs, ERA remark codes, and payer-specific rule. Proficiency in EHR systems. Excellent numerical accuracy and high attention to detail. Ability to work independently with minimal supervision. Must be able to efficiently perform written and oral communications with clients, co-workers, insurance, representatives and vendors. Familiarity of revenue cycle process. Primary Location: TampaWork Locations: Morsani Surgery Center 13330 USF Laurel Drive MDH 2nd Floor Tampa 33612Eligible for Remote Work: Hybrid RemoteJob: Patient Financial ServicesOrganization: Academic Medical Group IncSchedule: Full-time Scheduled Days: Monday, Tuesday, Wednesday, Thursday, FridayShift: Day JobJob Type: Hybrid RemoteMinimum Salary: 33,092. 80Job Posting: Oct 13, 2025, 7:57:29 PM

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** + Provides telephone, clerical, and data entry support for the Case Management team. + Responsible for initial review of assigned case levels to assist in Case Management assignment. + Reviews data to identify principal member needs and works under the direction of the Case Manager to implement care plan. + Schedules member visits with team members as needed. + Screens members using Molina policies and processes, assisting clinical Case Management staff as they identify appropriate medical services. + Coordinates required services in accordance with member benefit plan. + Promotes communication, both internally and externally to enhance effectiveness of case management services. + Processes member and provider correspondence. **JOB QUALIFICATIONS** **Required Education** HS Diploma or GED **Required Experience** 1-3 years' experience in an administrative support role in healthcare. **Preferred Education** Associate degree **Preferred Experience** 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. \#PJHS \#LI-AC1 Pay Range: $17.14 - $33.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

*** This role prefers candidates local to California and/or Pacific Time Zone*** Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Claims Examiner today with Work from Home. **Benefits** Work from Home offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** Come join our team as a Claims Examiner. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today! **Job Summary and Qualifications** The **Claims Examiner** primary function is to ensure correct adjudication of all claims for SCCIPA contracted plans. **DUTIES INCLUDE BUT NOT LIMITED TO:** Adjudicate claims, resolving all system edits and audits for hardcopy and electronic claims. Resolve provider and eligibility issues relating to received claims. Generate emergency reports/authorizations for all received claims which lack prior authorization. Adjudicate third party liability and coordination of benefit claims in accordance with policy. Review stop loss reports and identify members who are nearing reinsurance levels. Identify potential system programming issues and reports issues to supervisor. Provide technical support and training for claims processors. Recognize and appropriately route claims for carved out services according to Plan contracts. Understand Plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and processes claims using this knowledge. Understand general ledger accounts and posting of claims information to the appropriate accounts. Perform other duties as assigned. **KNOWLEDGE, SKILLS AND ABILITIES: This position requires the following minimum requirements:** Ability to communicate well with supervisors and co-workers Ability to analyze claim issues and "trouble shoot" claims problems Ability to work in a high volume, production-oriented environment Detail oriented with an ability to sit for extended period of time Ability to act as a resource and /or trainer for claims processors Ability to work under demanding performance standards for production and quality Technical competence with claims processing software Ability to understand and implement complex claims procedures **EDUCATION:** High school diploma or equivalent Knowledge of ICD-9, CPT, HCPC, and Revenue Coding Medical terminology preferred Knowledge of DOC and HCFA requirements preferred **EXPERIENCE:** Two (2) years of experience processing claims, with at least one year of claims adjudication experience required Physician Services Group (*********************************************************** is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Claims Examiner opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock the possibilities and apply today!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Job Description Benefits: $18-20/hr. to start Competitive Health & Welfare Benefits Monthly $43 stipend to use toward ancillary benefits HSA with qualifying HDHP plans with company match 401k plan after 6 months of service with company match (Part-time employees included) Employee Assistance Program that is available 24/7 to provide support Employee Appreciation Days Employee Wellness Events Minimum Qualifications: A minimum of two years' experience in medical billing and/or cash applications or equivalent experience in a healthcare environment. Prefer previous cash posting experience in a multiple lockbox environment. Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers. Essential Functions Has an understanding of the accounts receivable posting process for medical billing including charges, payments, and adjustments. Posting financial transactions through the use of automated systems and team processes. Accurately interprets insurance explanation of benefits to ensure proper posting. Retrieves and uploads 835 remittance files into patient account system ensuring file reconciliation including reviewing and posting exception files. Participation in optimizing productivity within the area. Maintains knowledge of the work area and optimizes the use of available technology. Researches all information needed to process and complete insurance and/or patient refunds by obtaining information from providers, insurance plans, ancillary services staff, and patients. Accurately processes insurance and patient refund requests by demonstrating an advanced understanding of the coordination of benefits and eligibility requirements. Receives and processes all refunds utilizing insurance contracts and requirements for accuracy. Processes and posts refund checks as received into the patient accounting system. Establishes and maintains effective communication with physicians, staff, and other departments as required. Accepts and completes additional requests from the Cash Applications Supervisor. Adheres and understands the Business Office rules and regulations in regards to Medicare and HIPAA guidelines. Effectively forwards accounts requiring work up or resubmission to the business office staff. About us: The Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!? #1 for Orthopedic Practices #1 for Healthiest Healthcare Employers #3 for Best Healthcare Workplace Culture Winner in Best Places to Work

Job Description Responsible for portaling and scanning paper documents into electronic medical records for upcoming patient appointments. Responsible for reviewing patient records to add comorbid conditions to patient problem list. Responsible for electronically processing patient health information. Clinical knowledge and understanding of medical terminology to correctly identify health information in medical charts. Principal Duties & Responsibilities: Example of Essential Duties: 1) Portal patient records from outside health systems 2) Review patient records for comorbid conditions to add to patient problem list 3) Accurately scan medical records into EHR system 4) Fax records to physician offices or Hospitals 5) Answer phones 6) Ability to identify patient medical record documents by name. Other Essential Duties May Include (but are not limited to): Handle requests for release of patient medical information according to HIPAA rules and copy service contract. Other duties as assigned. Knowledge, Skills & Abilities Required: Required: - Knowledge of comorbid conditions - Clinical knowledge and ability to read and understand medical charts - Ability to accurately identify medical record documentation by name for electronic filing. - Excellent customer relations and phone protocol - Excellent organizational skills required. - Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame. - Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed. - Demonstrates adaptability to expanded roles. - Adheres to all clinic policies and procedures. Education: - HS diploma or GED Preferred: - Previous experience in a medical office, in medical coding, or in medical records.

BroadPath is hiring a work from home, detail-oriented medical **Claims Examiner** looking to make a significant impact in the healthcare industry. Join our remote team as a Claims Examiner and play a crucial role in ensuring the financial integrity and efficiency of our healthcare organization. The Claims Examiner's will be responsible for accurately processing a wide range of claims, identifying and resolving complex issues, and providing top-notch customer service to our valued providers and members. **Compensation Highlights:** + Base Pay: $17.00 per hour + Pay Frequency **:** Weekly **Schedule Highlights:** + Training Schedule: 5 days, Monday-Friday, 8:00 AM - 5:00 PM PST + Production Schedule: Monday-Friday, 8:00 AM - 5:00 PM PST, no weekends! **Responsibilities** + Adjudicate a variety of claims, including routine and complex cases, resolving system edits and audits for both hardcopy and electronic submissions + Effectively communicate with providers and members to address issues related to claims, eligibility, and authorizations + Generate emergency reports and authorizations for claims lacking prior approval + Process third-party liability and coordination of benefit claims in accordance with company policies + Assist in the review of stop loss reports to identify members approaching reinsurance thresholds + Escalate potential system programming issues to supervisors for resolution + Provide guidance and training to less experienced claims processors + Recognize and appropriately route claims for carved-out services according to plan contracts + Apply knowledge of plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans, and capitation arrangements + Collaborate with the Accounting team to ensure accurate posting of claims information to general ledger accounts + Work closely with Customer Service and Provider Services departments on large claim projects and adjustments + Interpret benefit and plan details for customers through the use of the cut-log system when necessary + Assist senior examiners in the adjustment of complex claims + Perform other duties as assigned by management **Qualifications** + High school diploma or equivalent + 1-3 years of medical claims processing experience + Medicare Claims Experienc + Knowledge of ICD-9, CPT, HCPC, and Revenue Coding + Strong analytical and problem-solving skills to address claim issues and troubleshoot problems + Excellent communication and customer service skills to effectively interact with providers and members + Attention to detail and the ability to maintain focus in a high-volume, production-oriented environment + Proficiency with claims processing software and technology + Understanding of medical terminology, coding, and healthcare industry regulations + Ability to learn and apply complex claims procedures and policies + Teamwork skills to collaborate with colleagues and provide training or support + Adaptability to work under demanding performance standards for production and quality **Systems Experience:** + QXNT **Diversity Statement** _At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!_ _Equal Employment Opportunity/Disability/Veterans_ _If you need accommodation due to a disability, please email us at_ _*****************_ _. This information will be held in confidence and used only to determine an appropriate accommodation for the application process._ _BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law._ _Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location._

Job Details 95 00 Corporate - Asheville, NC Fully Remote Admin - ClericalJob Posting Date(s) 09/16/2025Description Ensure all insurance and patient payments are posted quickly and accurately. Responsibilities include, but are not limited to, the following: Daily Duties Posts all insurance and patient payments by line item; batches them according to protocol Alerts Manager when payments do not match contractual amounts; looks for underpayments and silent PPOs Processes requests for refunds, and submits to Manager for approval Ensures lock box totals balance with what is posted into the computer system Maintains working knowledge of charge entry, and insurance follow up protocols; provides back-up Reimbursement Specialist as needed Other Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice. Maintains detailed knowledge of practice management and other computer software as it relates to job functions. Attends OSHA, HIPAA, and OIG training programs as required. Attends all meetings as requested including regular staff meetings. Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry. Performs any additional duties as requested by the CFO and/or Director of Central Billing Services. Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes. Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline. Supervisory Responsibilities:This job has no supervisory responsibilities Typical Physical Demands: Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports. Typical Working Conditions: Normal office environment. Occasional evening or weekend work.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary 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 Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Prefer knowledge of capitated managed care environment Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $23.98 - USD $30.57 /Hr.

Responsible for portaling and scanning paper documents into electronic medical records for upcoming patient appointments. Responsible for reviewing patient records to add comorbid conditions to patient problem list. Responsible for electronically processing patient health information. Clinical knowledge and understanding of medical terminology to correctly identify health information in medical charts. Principal Duties & Responsibilities: Example of Essential Duties: 1) Portal patient records from outside health systems 2) Review patient records for comorbid conditions to add to patient problem list 3) Accurately scan medical records into EHR system 4) Fax records to physician offices or Hospitals 5) Answer phones 6) Ability to identify patient medical record documents by name. Other Essential Duties May Include (but are not limited to): Handle requests for release of patient medical information according to HIPAA rules and copy service contract. Other duties as assigned. Knowledge, Skills & Abilities Required: Required: - Knowledge of comorbid conditions - Clinical knowledge and ability to read and understand medical charts - Ability to accurately identify medical record documentation by name for electronic filing. - Excellent customer relations and phone protocol - Excellent organizational skills required. - Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame. - Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed. - Demonstrates adaptability to expanded roles. - Adheres to all clinic policies and procedures. Education: - HS diploma or GED Preferred: - Previous experience in a medical office, in medical coding, or in medical records.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule CalPERS retirement 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 Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Knowledge of capitated managed care environment preferred Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $23.98 - USD $30.57 /Hr.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary * 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 Education & Requirements * Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting * Processing of Medicare, Medi-Cal, or Commercial claims required * Proficient in rate applications for Medi-Cal and/or Medicare pricers * High school diploma or GED required Key Qualifications * ICD-9 and CPT coding and general practices of claims processing * Prefer knowledge of capitated managed care environment * Microcomputer skills, proficiency in Windows applications preferred * Excellent communication and interpersonal skills, strong organizational skills * Professional demeanor * Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $23.98 USD Hourly - $30.57 USD Hourly