Job Overview
The Healthcare Data Entry specialist is responsibile for accurately entering, reviewing, and processing healthcare claims and related information into the organization's designated system for further adjudication and processing.
This position requires a high level of accuracy, attention to detail, consistency, and the ability to perform repetitive computer-based tasks for extended periods. The employee must be able to work independently in a remote environment while maintaining productivity, confidentiality, and adherence to established procedures.
The position may also involve assisting callers with basic claims-related inquiries, verifying information, directing calls to the appropriate department, and providing general assistance withing the employee's scope of responsibility.
Although the position is primarily remote, the employee may be required to report to the office periodically for initial of additional training, meetings, quality review, system training, or other opeational needs.
Essential Duties and Responsibilities
Claims Data Entry and Processing
- Enter healthcare claims and related information accurately into the designated claims processing system.
- Review claim information for completeness, accuracy, and consistency prior to submission for further adjudication.
- Enter demographic, provider, member, service, diagnosis, procedure, billing, and other claim-related information as required.
- Follow established procedures for identifying and correcting data entry errors.
- Review electronic and/or paper documentation associated with claims.
- Identify missing, incomplete or inconsistent information and follow established procedures for resolution.
- Route claims or related issues to the appropriated department or individual when addtional review is required.
- Maintain accurate documentation of work performed and issues identified.
- Process assigned work withing established productivity and turnaround-time expectations.
- Perform repetitive date-entry and processing functions accurately and consistently.
Customer/Caller Assistance
- Answere or assist with incoming calls related to claims or general claim-status inquiries, as assigned.
- Provide basic information regarding claim status, processing, or other matters withing the employee's scope of responsibility.
- Verify information is in accordance with established procedures before discussing claim information
- Refer complex, sensitive, or unresolved issued to the appropriate department or supervisor.
- Maintain professional, courteous, and respectful communication with members, providers, office staff and other callers.
- Document calls and actions taken when required.
Quality and Compliance
- Maintain strict confidentiality of protected health information (PHI) and other confidential information.
- Follow HIPPA privacy and security requirements and organizational policies.
- Follow applicable federal and state requirements, payer guidelines, and internal claims-processing procedures.
- Maintain the security of passwords, loging credentials, computer equipment and other company resourches.
- Immediately report suspected privacy, security, or data-entry errors according to established procedures.
- Participated in quality assurance activities, audits and performance reviews.
- Complete required training and maintain competency in assigned systems and procedures.
Qualifications
- Experience with healthcare claims processing or medical billing.
- Experience with electronic claims or practice-management systems.
- Basic understanding of healthcare terminology.
- Basic understanding of medical insurance and claims terminology.
- High School Diploma
Pay: $20.50 - $22.00 per hour
Expected hours: 20.0 per week
Work Location: Hybrid remote in March Air Reserve Base, CA 92518
