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Responsible for verifying Medi - Cal eligibility; determining coordination of benefits (COB); processing Fee For Service (FFS) and Child Welfare Services (CWS) provider claims; answering provider questions; providing back up for Claims Service Representatives as needed.
Verify Medi-Cal eligibility and determine coordination of benefits (COB).
Process provider claims with a minimum of 97% procedural accuracy and 99% financial accuracy.
Maintain daily claims production standard.
Maintain working knowledge of plan benefit designs. Analyze and authorize claim payments according to policies and provisions of plan.
Handle priority claim requests timely and accurately.
Review and complete pended claims on a daily basis.
Enter and update client demographics and insurance information into the Designated Data System (DDS).
Process the Medi - Cal denials received by Billing Unit and Medi - Cal denied Services Report within established time frames. Recoup paid claims determined to have been paid in error.
Position requires access to electronic applications and documents which contain Individually Identifiable Health Information and Personal Health Information.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.