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Claims Reviewer Clerk

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  • Full-Time
  • Ged/High School Diploma
  • None
  • Nipomo
  • Santa Maria, CA
  • $18.50 / hr

Needed in Nipomo, CA. Duties include: Using reports to identify patient charts notes, consultations, medication documentation, & referral orders; Working with Specialty offices or Referral Department to retrieve missing consultation documentation; Contacting pharmacies to obtain copy of prescription; Using pharmacology references to determine generic from brand name prescription drugs; Working with office staff, case managers, & physicians to ensure reconciliation is completed to reflect medications from claims report; Ensuring referral order is in chart for patients seen by & receiving prescription drugs from Consulting Specialist; Faxing consultations & prescription slips to Athena for scanning into patient’s EMR; Reviewing invoice pricing; Preparing & maintaining accounting documents & records; Demonstrating professionalism & quality customer service using AIDET Standards; Demonstrating adherence to & observing all safety policies & procedures, cultural sensitivity, & competence with patients; Maintaining & adhering to HIPAA, employee confidentiality, & privileged communications (patient, employee, & corporation); Meeting deadlines; Conducting routine reports & correspondence. Required qualifications: High school diploma/GED; Possess current valid CA driver's license (Class C); Able to pass criminal history background check & drug screen upon hire; Working knowledge of MS Excel; Exp. with word processing, spreadsheets, email, & keyboarding; MS Office, Excel, & Google Suite skills; Ability to work with high volume of claims data/records; Ability to read & interpret documents such as safety rules, operating & maintenance instructions, & procedure manuals; Ability to speak effectively before groups of customers or employees; Ability to add, subtract, multiply, & divide in all units of measure, using whole numbers, common fractions, & decimals; Ability to compute rate, ratio, & percent as well as draw & interpret bar graphs; Annual health examination; Annual Tuberculosis skin test clearance or chest x-ray; Proof of immunity to MMR, Varicella, & Hepatitis B; Proof of Tdap vaccine; During current flu season, must provide proof of influenza vaccine. Health screening requirements are subject to change. Working knowledge of EHR preferred. Basic accounting skills preferred. Flexible work schedule that may include evenings/weekends, & travel as needed. Mon-Fri/7:30am-4:00pm. Wage: $18.50 hr. (#3.1019.102 – Santa Maria)