Medi-Cal Claims Processing Specialist
总结：我们是谁：高通是一家全球提供全道客户体验和商业支持解决方案的供应商。从呼叫中心支持到领先代人到电子商务实现，我们在整个客户旅程中为我们的客户及其客户提供支持。我们的使命是帮助尽可能多的人通过创造不断增长的就业机会来追求他们的全部职责 - - 作为个人和社会成员。我们努力成为客户选择的合作伙伴。在高通，你将不仅找到一份工作，你会发现一个成长的地方，发展你的职业生涯，并成为一个有助力，目的驱动的团队的一部分。责任 你会做什么：科尔福正在寻求详细的医疗卡索赔处理专家，以精确有效地审查和解决暂停的索赔。理想的候选人将拥有医疗保健支付知识，强大的分析技能以及能够在保持 HIPAA 合规的情况下应用政策和法规的能力。·验证会员资格，提供商信息，授权要求和受惠额度。·根据需要检查医疗记录，索赔文件和收费信息。·识别并纠正索赔错误并做出适当的裁决决定。·在确定期限和生产力标准内准确解决索赔问题。· 应用医疗卡的政策，法规和支付指南。·保护机密信息并保持符合 HIPAA 要求。你将带来的资格：· 在医疗卡/Medi-Cal 申请处理和裁决方面至少有两 (2) 年经验。· 对医学术语和医疗保健收费实践的知识。·熟悉 CTP,HCPCS 和 ICD-10编码概念。· 强烈关注细节，以确保准确，高质量和及时的索赔裁定能力。· 解释和运行政策，程序和监管要求的能力。· 具有强大的组织，时间管理和优先级技能。· 能够在快速的生产环境中有效工作的能力。·阅读，理解和应用既定政策指南的能力。· 对索赔处理系统和微软办公室应用程序的熟练知识。在家工作要求：· 高速度互联网通过有线以太网连接，无 Wi-Fi,卫星或热点 · 有线提供商 - 没有允许移动宽带连接 · 25 Mbps 的上传速度；50 Mbps 的下载速度
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Overview
Who We Are:
Qualfon is a global provider of omnichannel customer experience and business support solutions. From call center support to lead generation to ecommerce fulfillment, we support our clients and their customers throughout the customer journey.
Our mission is to help as many people as possible pursue their total vocation - as individuals and as members of society - by creating an ever-growing number of job opportunities as we strive to become the partner of choice for our clients.
At Qualfon, you’ll find more than just a job, you’ll find a place to grow, develop your career, and be part of a supportive, purpose-driven team.
Responsibilities
What you'll do:
Qualfon is seeking detail-oriented Medi-Cal Claims Processing Specialists to review and resolve suspended claims accurately and efficiently. The ideal candidate will have knowledge of healthcare billing, strong analytical skills, and the ability to apply policies and regulations while maintaining HIPAA compliance.
- Verify member eligibility, provider information, authorization requirements, and covered benefits.
- Review medical records, claim documentation, and billing information as needed.
- Identify and correct claim errors and make appropriate adjudication decisions.
- Resolve claim issues accurately within established deadlines and productivity standards.
- Apply Medi-Cal policies, regulations, and payment guidelines.
- Protect confidential information and maintain compliance with HIPAA requirements.
Qualifications
What you'll bring:
- Minimum of two (2) years of experience in Medicaid/Medi-Cal claims processing and adjudication.
- Knowledge of medical terminology and healthcare billing practices.
- Familiarity with CTP, HCPCS, and ICD-10 coding concepts.
- Strong attention to detail with the ability to ensure accurate, high-quality, and timely claims adjudication.
- Ability to interpret and apply policies, procedures, and regulatory requirements.
- Strong organizational, time-management, and prioritization skills.
- Ability to work efficiently in a fast-paced, production-driven environment.
- Ability to read, understand, and apply established policy guidelines.
- Proficiency in claims processing systems and Microsoft Office applications.
Work at Home Requirement:
- High-speed Internet via wired ethernet connection, no Wi-Fi, Satellite or Hot Spot
- Wired provider- No mobile broadband connections allowed
- Upload speed of 25 Mbps; Download speed of 50 Mbps
- The Internet service provider (ISP) must be highly stable with 1% or less packet loss
- Latency under 100ms
- Must have available cell phone or tablet with minimum system requirements of Android 8.0 and later or iOS14 or later and must install the Microsoft Authenticator (MFA) Application required by Qualfon IT.
Internet Reimbursement: Agents receive a $75.00 monthly stipend to help offset the cost of their home internet service while working remotely.
What We Offer:
We lead by example to ensure our fantastic team members and supervisors embrace and live the Qualfon Mission to make each person's life better.
- Paid training
- All team members can further their education and earn a college degree through the Qualfon University scholarship program
- Team members have FREE access to personal and professional support through the Qualfon Care Coaches
- Last but not least, Qualfon is dedicated to ensuring all team members have Fun@Work!
EEO Statement
QUALFON is an equal opportunity employer. QUALFON provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity, national origin, age, disability, genetic information (including testing and characteristics), marital status, ancestry, status as a covered veteran, uniformed servicemember status and any other characteristic protected under applicable federal, state or local law.
Pay Range
USD $24.00 - USD $24.00 /Hr.Originally posted on Himalayas