Medi-Cal Claims Processing Specialist

🔥 13 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $24 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Qualfon

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1995

📣 Marketing

📦 Logistics

🏥 Healthcare

Marketing • Logistics • Healthcare

Qualfon is a comprehensive provider of customer engagement solutions, specializing in services such as contact center operations, digital marketing, data analytics, and fulfillment. The company focuses on enhancing customer interactions and driving revenue through a blend of innovative marketing strategies and back-office support. With a strong commitment to customer care, Qualfon aims to improve customer loyalty and satisfaction across various industries.

📋 Description

• Review and resolve suspended Medi-Cal claims accurately and efficiently • Verify member eligibility, provider information, authorization requirements, and covered benefits • Review medical records, claim documentation, and billing information as needed • Identify and correct claim errors and make appropriate adjudication decisions • Resolve claim issues within established deadlines and productivity standards • Apply Medi-Cal policies, regulations, and payment guidelines • Protect confidential information and maintain HIPAA compliance

🎯 Requirements

• Minimum of two (2) years of experience in Medicaid/Medi-Cal claims processing and adjudication • Knowledge of medical terminology and healthcare billing practices • Familiarity with CTP, HCPCS, and ICD-10 coding concepts • Strong attention to detail for accurate, high-quality, and timely claims adjudication • Ability to interpret and apply policies, procedures, and regulatory requirements • Strong organizational, time-management, and prioritization skills • Ability to work efficiently in a fast-paced, production-driven environment • Ability to read, understand, and apply established policy guidelines • Proficiency in claims processing systems and Microsoft Office applications • High-speed internet via wired Ethernet connection; no Wi-Fi, satellite, or hotspot • Wired internet provider; no mobile broadband connections • Upload speed of 25 Mbps and download speed of 50 Mbps • Internet service provider with 1% or less packet loss • Latency under 100ms • Available cell phone or tablet meeting minimum requirements of Android 8.0 or later or iOS 14 or later • Must install the Microsoft Authenticator (MFA) application required by Qualfon IT

🏖️ Benefits

• $75.00 monthly internet reimbursement/stipend • Paid training • Qualfon University scholarship program to earn a college degree • Free access to personal and professional support through Qualfon Care Coaches • Fun@Work