Medi-Cal Claims Processing Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Accurately and efficiently review and resolve suspended Medi-Cal claims.

• Confirm member eligibility, provider details, authorization requirements, and covered benefits.

• Assess medical records, claim documentation, and billing information as necessary.

• Identify and rectify claim errors, making appropriate adjudication decisions.

• Address claim issues within set deadlines and productivity standards.

• Implement Medi-Cal policies, regulations, and payment guidelines.

• Safeguard confidential information and uphold HIPAA compliance.

⛳️ Requirements

• At least two (2) years of experience in Medicaid/Medi-Cal claims processing and adjudication.

• Understanding of medical terminology and healthcare billing practices.

• Familiarity with CTP, HCPCS, and ICD-10 coding concepts.

• Exceptional attention to detail for precise, high-quality, and timely claims adjudication.

• Capability to interpret and implement policies, procedures, and regulatory requirements.

• Strong organizational, time-management, and prioritization abilities.

• Capacity to work effectively in a fast-paced, production-oriented environment.

• Proficiency in reading, understanding, and applying established policy guidelines.

• Familiarity with claims processing systems and Microsoft Office applications.

• High-speed internet via a wired Ethernet connection; no Wi-Fi, satellite, or hotspot.

• Wired internet provider; no mobile broadband connections.

• Minimum upload speed of 25 Mbps and download speed of 50 Mbps.

• Internet service provider with 1% or less packet loss.

• Latency under 100ms.

• Available cell phone or tablet that meets minimum requirements of Android 8.0 or later or iOS 14 or later.

• Must install the Microsoft Authenticator (MFA) application as required by Qualfon IT.

🏝️ Benefits

• $75.00 monthly internet reimbursement/stipend.

• Paid training.

• Qualfon University scholarship program to pursue a college degree.

• Complimentary access to personal and professional support through Qualfon Care Coaches.

• Fun@Work.