Required Skills & Abilities

• Skilled and experienced with best practices, standards, methods, and procedures of effective claims adjudication in the health care industry utilizing technology systems to automate processing. Ability to utilize modern office administrative practices and procedures including computer office applications, MS Suite for email, spreadsheets, presentations, and documentation.
• Knowledge of Medi-Cal, Medicare, and other insurance program regulations and managed care claims processing.
• Familiarity with Commercial insurance regulations in a managed care environment.
• Knowledge of medical terminology, CPT, ICD-9 Coding, and other available resource reference tools.
• Knowledge of automated health care claims processing systems.

Experience Requirements

• 3-5 years of experience with Medi-Cal and other insurance programs effective claims management and claims adjudication in the healthcare industry.
• Must have experience with processing 837 claims, 835 EOB, and state payment processing.
• Experience with automated healthcare claims processing systems with a preference for knowledge of Netsmart’s Managed Services Organization (MSO) and California Practice Management (CalPM) modules.

Training and Experience: Sufficient education, training, and experience to demonstrate the possession and direct application of the following knowledge and abilities.