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Claims Processor (Veteran or Spouse)
Workforce Opportunity Services Baton Rouge, LA
Dec 11, 2019
Full time
Program Start Date:  December 30th , 2019 Overview: ​​​​​This program provides  NO COST , job readiness training to selected individuals. We are looking for Military Veterans and Spouses for this program. Individuals who get a sense of accomplishment from assisting others. Those who excel will be offered  Full-Time employment  with our partner. Once hired, additional job specific training will be provided. This unique work-study opportunity differs from the typical job. Our solution, for those who are ready, will put you on the right personal, academic, and professional path while providing the necessary support and mentorship to help keep you there. Candidate Profile: Military Veterans, National Guard, Reservists and Military Spouses looking for a long term career Results-driven Passionate about helping others Meticulous attention to detail  Comfortable navigating multiple tabs and using dual screens Ability to work in a team-based environment Available to commit to full-time schedule beginning December 30th , 2019 Computer proficient and comfortable with Microsoft Office suite Must be able to successfully pass background check Program Information: Phase 1 - Job Readiness Training  (3 weeks ): If chosen for the program , training will begin December 30th , 2019 through January 17th , 2020 Training will be held during normal business hours (Monday-Friday/ 9am-5pm ) Training will include the following: Claims Processing Interpersonal Skills Job Readiness Training Compensation: $400 weekly stipend . This stipend is a miscellaneous payment (Form 1099) and is required to be reported to IRS when filing taxes. Phase 2 - Full-Time Employment (18+ Weeks) : Upon completion of the Job Readiness Training you will then move into Full-Time employment Full-time employment runs from January 20th, 2020 through May 22nd, 2020 Eligible for hire at our partner after May 22nd, 2020 Full-Time Employment Compensation: $15.00 /Hour (Plus Benefits)  Job Description: This entry level position is responsible for claims data entry, reviewing benefit eligibility, and processing claims approvals/denials for our Dental and Vision customers. Processors in this role must exercise independent judgment when making accurate and timely claim and benefit decisions. In addition, the processor will need to demonstrate the ability to operate across multiple systems simultaneously, use dual monitors, and perform in a paperless work environment. Qualifications: High school diploma or equivalent required. Data Entry experience preferred. Strong computer skills, must be able to work in a paperless environment, using multiple systems, with dual monitors Attention to detail and organizational skills Strong work ethic with consistent job attendance history Seeks out job challenges and opportunities to constantly improve skills Location: Baton Rouge, LA About WOS Founded in 2005, Workforce Opportunity Services (WOS) is a nonprofit dedicated to recruiting, training and placing underserved and veteran job seekers into long-lasting careers at prominent organizations. To date, WOS has served 5,300+ individuals through partnerships with more than 65 corporations in 60+ locations worldwide. For more information, visit  wforce.org
Medical Claims Processor
Secure Transportation Long Beach, CA, USA
Jan 10, 2020
Full time
Summary Description Encounters data is essential for monitoring and measuring managed care quality, finance, utilization and compliancy with state and contractual requirements. It is a critical source of information for rate setting, HEDIS score and risk adjustment. The Encounter team is responsible for receiving, capturing, validating, tracking submission, reconciling response files and error correcting rejections of encounters data rendered to members. The Claims Processor will be supporting with reviewing, logging, batching, creating and issuing Claims Acknowledgement letters and Return to Provider letters, processing of claims, along with handling providers inquiry to claims payment. Key Tasks and Responsibilities • Review for accuracy and completeness of inbound claims. • Verify member eligibility. • Validate calculation of the reimbursable amount. • Create an Excel spreadsheet with necessary data items that serves as upload for payment from Finance. • Update Itineris with necessary member, rates and provider data. • Approve claims that are complete, eligible and accurate data elements. • Reject claims that are incomplete, inconsistent data elements or duplicates. • Print and mail Claims Acknowledgement letter to providers. • Print and mail return letter to providers with rejection reason. • Manage and respond to provider inquiries regarding claims status and payment by researching system for claims history. • Identify issues, report to Director and propose solution. Education & Training • Required: High School Diploma or GED • Preferred: Medical claims processing and billing Knowledge and Experience • Knowledge of CMS 1500 forms and fields. • Knowledge of required transportation HCPCS codes, modifiers, provider Medicaid ID, TIN and NPI. • Knowledge of state Medicare and Medicaid program guidelines and requirements. • Strong understand of Itineris and Excel software. • Strong data entry skills. • Excellent customer Service. Core Competencies • Strong organizational skills • Ability to communicate efficiently with multiple areas of the organization • Strong written and verbal communication skills • Track claims, payment and rejections • Ability to multi-task with frequent interruptions • Exceptional attention to detail and accuracy • identify missing or invalid claims data • Abide to deadlines Working Conditions • This is a Full time hourly position. • Benefits after 60 days include medical, dental, vision, voluntary life and 401(k). • No travel is required. Physical Requirements  • This position requires working on a sitting position working on a computer and operating a keyboard and a mouse as well as other office equipment like phones and printers and filing documents.