Responsibilities
In this key position, you will provide accurate and timely data entry as you review and adjudicate claims for services rendered in inpatient, ambulatory and outpatient settings for all contracted lines of business.
You will ensure compliance with regulatory guidelines, contract provisions and established policies and procedures.
Your role will involve receiving work assignments via batch, report, in-basket pools, work queues or other methods.
You will be responsible for meeting quality, productivity, service-level and turn-around requirements in accordance with the departments performance standards and regulatory requirements.
Qualifications
Were seeking a self-directed, customer-focused professional with:
Four or more years of medical claims payment experience in an HMO setting
Expertise with claims adjudication policies, procedures and processes
In-depth knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary and professional claims (e.g., Medicare fee schedules, DRG, APC, ASC, SNF-RUG, etc.)
Familiarity with CPT, HCPCS, ICD-10, ASA, Revenue Codes, etc.
Understanding of medical terminology
Ability to key 6,000-8,000 keystrokes or type 40-50 wpm with high accuracy
Must be detailed oriented, attentive, and highly organized
Computer proficiency with Microsoft Word and Excel
Solid background with claims adjudication systems (e.g., EPIC-Tapestry, EZ Cap, QNXT, IDX, etc.)
Goal oriented, deadline driven with ability to meet production/quality standards
Willingness to learn new technologies, practices and procedures
UCLA is an Equal Opportunity/Affirmative Action employer.
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.