Medical Claims - B2B Staffing Services

  Job Title: Medical Claims

  Job Description: Summary: Responsible for timely and accurate sorting, screening and batching of all Medicaid claim forms, as well as coding of third party payer; and Medicare Crossover if required by state contract. Also accountable for preparing and mailing provider remittance advice and ?Return to Provider? letters in an efficient manner. Essential Functions: o Opens and sorts all incoming mail. o Screens medical claim forms for pertinent information. o Batches medical claim forms by claim type. o Completes Code Sheets for Third Party Liability and/or Medicare Crossover claims. o Prepares, for mailing, Return to Provider (RTP) letters for returning claims with missing information required to enter into the claims payment system. o Prepares Remittance Advices weekly for mailing to providers. o Meets established production and quality standards. o Supports all departmental initiatives in improving overall efficiency. Knowledge/Skills/Abilities: o Ability to lift up to 50 lbs o Basic knowledge of Microsoft Office Outlook o Ability to abide by Molina?s policies o Ability to maintain attendance to support required quality and quantity of work o Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) o Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: High School Diploma or equivalent GED Required Experience: 2-4 years of relevant experience

  Release Comments: **Please do not submit any candidate who has been previously qualified, interviewed, or disqualified  on REQ 2345. Same manager, replacement requisition.


Summary: Responsible for timely and accurate sorting, screening and batching of all Medicaid claim forms, as well as coding of third party payer; and Medicare Crossover if required by state contract. Also accountable for preparing and mailing provider remittance advice and ?Return to Provider? letters in an efficient manner. Essential Functions: o Opens and sorts all incoming mail. o Screens medical claim forms for pertinent information. o Batches medical claim forms by claim type. o Completes Code Sheets for Third Party Liability and/or Medicare Crossover claims. o Prepares, for mailing, Return to Provider (RTP) letters for returning claims with missing information required to enter into the claims payment system. o Prepares Remittance Advices weekly for mailing to providers. o Meets established production and quality standards. o Supports all departmental initiatives in improving overall efficiency. Knowledge/Skills/Abilities: o Ability to lift up to 50 lbs o Basic knowledge of Microsoft Office Outlook o Ability to abide by Molina?s policies o Ability to maintain attendance to support required quality and quantity of work o Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) o Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: High School Diploma or equivalent GED Required Experience: 2-4 years of relevant experience