Claims Adjuster
Molina Healthcare - Long Beach, CA

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Job Summary

Provide in depth research and adjudication of underpaid and/or denied claims to ensure that all components, i.e., member, provider, authorization, claim and system are valid and correct for accurate processing. Interface with other departments and/or health plans to resolve outstanding issues affecting claims rework.
Essential Functions *

Researches tracers (if applicable), adjustments and re-submissions. Adjudicate or re-adjudicate claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. Completes a minimum of 90 adjustments for HCFAs and Outpatient UBs and 42 adjustments for Inpatient UBs, daily. *
Handles special projects as assigned and required by changes in claims payment policies or contracting methodologies. *
Manages defect reduction via being pro-active in identifying error issues and trends and communicating the issue/improvement idea to management on a weekly basis or within scope of work. *
Leads overall performance accountability (attendance, communication, flexibility, adaptability, interpersonal skills, teamwork and cooperation).
Knowledge/Skills/Abilities *

Must know computerized claims processing systems. *
Data entry and 10-key skills by touch and sight. *
Knowledge of CPT and ICD9 coding, procedures and guidelines. *
Medical Terminology. *
Must have the ability to speak, read, write and understand English satisfactorily for effective communication. *
Accuracy of claim payments during processing and/or audit; analytical ability. *
Excellent verbal and written communication skills *
Ability to abide by Molina's policies *
Maintain regular attendance based on agreed-upon schedule *
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) *
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: *
High School graduate. *
Some college level general education courses helpful.

Required Experience: *
3+Years experience in claims adjudication. *
Experience in processing all types of medical claims required.

Required Licensure/Certification:

Preferred Education:

Preferred Experience:

Preferred Licensure/Certification:

To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

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

Molina Healthcare - 11 months ago - save job - block
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About this company
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Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare's mission is to help Medicaid and...