• Medi-Cal Claims Specialist

    Location US-CA-Anaheim
    Job ID
    2018-3227
    Category
    Eligibility
  • About The Company

    MedData, a MEDNAX (NYSE: MD) company, is a technology-enabled services organization that improves financial outcomes for hospitals by enhancing the patient experience and expanding their access to healthcare. The MedData managed services program includes a range of patient access and communications, revenue cycle management, and consulting and analytics solutions for healthcare systems, including billing, coding, patient balances, eligibility and enrollment, third party liability, and mobile apps.
     
    At MedData, we take great pride in our company, in each other, and in our 30+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData’s growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.

    Job Description

    MedData has an excellent career opportunity available as a Medi-Cal Claims Specialist to work in an office setting located in Anaheim, CA. The schedule for this full time role is Monday- Friday 8am-4:30pm. 

     

    POSITION OVERVIEW:

    The purpose of this position is to prepare and submit inpatient and outpatient claims to Medi-Cal (California Medicaid) and to follow-up these claims until payment is received and/or accounts are resolved.

     

    ESSENTIAL JOB FUNCTIONS:  

    • Process claims unbilled reports in the hospital systems and upload to Cardon’s system all accounts that require claim submission;
    • Verify eligibility, aid code/member benefits, and TAR requirements of each claim to be submitted;
    • Review UB04 information, correct claim errors, and transmit the claims to Medi-Cal for reimbursement;
    • Track receipt of each claim, and periodically call or check online for claim status;
    • Work Cardon’s claims dashboard for claims follow-up and documentation;
    • Submit replacement claims for those denied that could still be resubmitted timely;
    • For claims paid, verify receipt of payment in the hospital system, and review if paid in accordance with expected reimbursement;
    • File Claims appeals or CIFs for underpaid claims or those denied that could no longer be resubmitted timely;
    • Update both the hospital and Cardon systems with the progress and outcome of the claim submission process;
    • Reports and help address all barriers to successful claim submission;
    • Requests adjustments to resolve correctly paid, underpaid or denied claims;
    • Assist in the preparation of hospital claims report;
    • Closely communicate and coordinate with the client hospitals with respect to their Medi-Cal claims;
    • Respond to other tasks assigned by the department manager.

     

    QUALIFICATIONS

    • High school graduate, preferably with 2 years college.
    • At least 1 year experience with hospital (UB04) Medi-Cal billing and collections.
    • Read, speak, write and understand the English language fluently
    • Keyboarding skills, at least 35 wpm
    • Working knowledge of Outlook, Word, and Excel
    • Dependable and highly detailed individual
    • Willingness to learn new systems and functions
    • High commitment to customer service to our internal and external clients.
    • Possess a high level of integrity – must show good judgment and confidentiality at all times
    • Must occasionally lift and/or move up to 20 pounds

     

    PHYSICAL REQUIREMENTS:

     

    While performing the responsibilities of the job, the employee is required to talk and hear. The employee is often required to sit and use their hands and fingers, to handle or feel. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision.

     

     

    This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.

     

     

    To join our team of 2,000 employees and growing, please apply directly to this posting. IND123


    MedData is an equal opportunity employer.

     

    Search: Medi-Cal, UB04, hospital, billing, claims, Medicaid

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