Claims Auditing Specialist (Institutional) Telecommute
Company: Inland Empire Health Plans
Location: Rancho Cucamonga
Posted on: May 3, 2021
Job Requisition ID: 4476
Under the direction of the Claims
Quality Assurance (QA) Manager and Supervisor, the Claims
Specialist Quality Assurance I (CSQA) responsible
for ensuring the integrity of
all data created and updated by the
Claims Processing staff. The CSQA will utilize quality auditing
tools, identify training needs, and define effective and efficient
methods for accurate data entry and adjudication.
Major Functions (Duties and
1. Review and
assess data reports and audit
Claim Processor output to confirm
payment accuracy and completeness of data entry.
2. In-house expert for claims adjudication (Coordination of
Benefits, pricing, contract interpretation, coding, and resolution
of claims issues.)
3. Ensure that all identified errors are corrected in an
4. Be an active participant in the Claims Department’s
initiatives and participate in the Claims Coaching process, MDI
5. Assist with the processing of claims when necessary to
address claims backlogs. Process approved Stop Loss
Two (2) years
experience in examining and
processing institutional and professional claims.
Experience in a managed care environment helpful with familiarity
of Webstrat, Optum and CMS pricing.
Medicare/Medi-Cal experience preferred.
High school diploma or GED required.
ICD-9/ ICD-10 and CPT coding and
general practices of claims processing.
Microcomputer skills, proficiency
in Windows applications preferred. Excellent communication and
interpersonal skills, strong organizational skills.
Commitment to Team Culture
The IEHP Team environment requires
a Team Member to participate in the IEHP Team Culture. A Team
Member demonstrates support of the Culture by developing
professional and effective working relationships that include
elements of respect and cooperation with Team Members, Members and
associates outside of our organization.
Sitting - CONSTANTLY
Gross Manipulation - CONSTANTLY
Keyboarding: 10-Key - CONSTANTLY
Keyboarding: Traditional - CONSTANTLY
Use of computer mouse - CONSTANTLY
Fine manipulation - CONSTANTLY
Use hands/fingers to handle or feel - CONSTANTLY
Side to side motion of the wrist - CONSTANTLY
Turning/rotation of wrist or hand - CONSTANTLY
Up and down flexion of wrist - CONSTANTLY
Regular and reliable attendance - CONSTANTLY
Develop and maintain positive work relationships -
Indoors - CONSTANTLY
Problem Solving - FREQUENTLY
Pay rate will commensurate with experience
Inland Empire Health Plan (IEHP) is the largest not-for-profit
Medi-Cal and Medicare health plan in the Inland Empire. We are also
one of the largest employers in the region. With a provider network
of more than 6,000 and a team of more than 2,000 employees, IEHP
provides quality, accessible healthcare services to more than 1.2
million members. And our mission and core values help guide us in
the development of innovative programs and the creation of an award
winning workplace. As the healthcare landscape is transformed, were
ready to make a difference today and in the years to come. Join our
Team and Make a Difference with us! IEHP offers a Competitive
salary and a benefit package with a value estimated at 35% of the
annual salary, including medical, dental, vision, team bonus, and
Keywords: Inland Empire Health Plans, Rancho Cucamonga , Claims Auditing Specialist (Institutional) Telecommute, Other , Rancho Cucamonga, California
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