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US-Customer Service Representative-3
West Sacramento, CA
West Sacramento
CA
95798
Date
: Today (Feb-26-21)
2021-02-26
2022-02-18
US-Customer Service Representative-3
West Sacramento, CA
Today (Feb-26-21)
Work Authorization
US Citizen
GC
H1B
EAD (OPT/CPT/GC/H4)
Preferred Employment
Corp-Corp
W2-Permanent
W2-Contract
1099-Contract
Contract to Hire
Job Details
Experience
:
Midlevel
Rate/Salary ($)
:
Market
Duration
:
12 months
Sp. Area
:
Others
Sp. Skills
:
Others
Consulting / Contract
CONTRACTOR
Direct Client Requirement
Required Skills
:
No Details
Preferred Skills
:
Domain
:
IT/Software
Work Authorization
US Citizen
GC
EAD (OPT/CPT/GC/H4)
H1B
Preferred Employment
Corp-Corp
W2-Permanent
W2-Contract
1099-Contract
Contract to Hire
Job Details
Experience
:
Midlevel
Rate/Salary ($)
:
Market
Duration
:
12 months
Sp. Area
:
Others
Sp. Skills
:
Others
Consulting / Contract
CONTRACTOR
Direct Client Requirement
Required Skills
:
No Details
Preferred Skills
:
Domain
:
IT/Software
National Systems America LLP
Plano, TX
Post Resume to
View Contact Details &
Apply for Job
Job Description
:
Description: BPS Healthcare American Documented Workers only Day Shift Location: West Sacramento Claims Appeals Examiner 3.1 Job Description: - Examine returns and payments from multiple business entities to determine and make appropriate adjustments, such as approving or denying refunds and claims - Analyze and review claims based on claim types: long term care, inpatient, outpatient, or medical using CA-MMIS program - Calculate provider rate based on the provider rate master file and process adjustments as needed - Complete Claim Inquiry Forms to process provider appeals or claims - Respond to providers in written form by entering appropriate paragraph codes into the appeals sub-system and/or creating text to clarify the response - Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation - Maintain performance within defined qualitative and quantitative objectives - Review and resolve provider appeal within provider manual guidelines - Provide clerical support to management as needed - Ability to research the Provider Manual and policy set by the Department of Health Care Services - Completed Claim Inquiry Forms and Account Receivable to process the provider appeal or claim - Verify recipient eligibility and benefits, revenue, and ICD-9 codes - Ensure timeliness guidelines are met by reviewing the provider documentation Knowledge and Skills: - Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the job - Specific level of software skills as required by the work unit - Must have excellent problem-solving skills - Good verbal and written communication skills - Detailed oriented Education and Experience Required: - High school education or equivalent - 1-3 years' experience preferred - Must be a proficient typist and have a minimum of 50 WPM while maintaining a 99.9% accuracy
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