Claims Processor

Job Summary

A company is looking for a Claims Processor II.

Key Responsibilities

• Process outpatient professional and institutional claims accurately and expediently
• Ensure compliance with quality program goals including HEDIS, CAHPS, and NCQA Accreditation
• Handle various types of claims such as lab, radiology, and behavior health

Required Qualifications

• Minimum of two years of experience in adjudicating outpatient claims, preferably in an HMO or Managed Care setting
• Experience processing Medicare, Medi-Cal, or Commercial claims
• High school diploma or GED required
• Proficient in rate applications for Medi-Cal and/or Medicare pricers
• Knowledge of ICD-9 and CPT coding practices