This career opportunity is located in our Rancho Cordova, CA regional office.
Summary: The Examiner is in daily contact with team members, clients and providers. This position reports to the Claims Supervisor. A cheerful, competent and compassionate attitude will directly impact the productivity of the team. Attendance can also directly impact the satisfaction level of our clients and retention of our accounts.
Essential Duties and Responsibilities: include the following. Other duties may be assigned.
- Processes claims accurately, efficiently and within quality/quantity requirements
- Exhibits an attention to detail and a strong work ethic
- Can interpret Plan Documents
- Can access research tools for accurate claims entry
- can be organized and manage time and resources efficiently and effectively
- Has thorough knowledge of coding structures (CPT, HCPCS, Revenue codes, ICD 9/10 etc.)
- Can perform arithmetic calculations
- Has knowledgeable of COB
- Has familiarity with benefits and benefit calculations
- Can understand all types of claims pricing (Network, Medicare, RBP (Reference
- Based Pricing) and UCR (Usual, Customary and Reasonable, etc.)
- Performs duties in a HIPAA compliant manner
- Participates as a Team Member to ensure the smooth operation of the entire department
- Maintains guidelines and notes with attention to detail to enable accurate claims processing
- Maintains quantity/quality department goals regarding the number of claims entered and
- accuracy percentages.
- Completes other projects as assigned.
- Complies with company policies and procedures as outlined in the Employee Handbook
- Complies with department policies and procedures
- Assists in cross-training other employees at the Supervisor or Claims Manager’s request
- Performs special projects at the request of management
- Regular, predictable attendance is required.
- Can get along and work effectively with others.
Supervisory Responsibilities: This job has no supervisory duties.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: Bachelor’s degree (B.A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports, and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
Mathematical Skills: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Computer Skills: To perform this job successfully, an individual should have knowledge of Internet software and the Microsoft Office Suite of products. Knowledge of basic office equipment should include: Internet and email, copy and fax machines, postage meter and telephone.
Certificates, Licenses, Registrations: Relevant training in medical claims processing and/or related certification, a plus.
Physical and Emotional Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The inability to cope with a stressful work environment does not constitute a protected disability.
While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, and talk or hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually very quiet.
Equal Employment Opportunity Policy Statement: Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.