Associate Health Information Management Representative - Administration

Business Professional
Heritage Healthcare
R316772 Requisition #
We are looking for a Associate Health Information Management Representative with $1,000 Sign-On Bonus for the Administration Department at Heritage Healthcare.
Location: Anaheim, CA
Work Schedule:  Full time - 80 Biweekly Hours
Shift:  8-hour, Days
Job Summary:
Working under the direction of the Manager, Support Services this position is critical to ensuring claims compliance and timeliness with AB1455 as well as Claims Department's policies and procedures.  In addition, the Support Services Clerk I position is responsible for identifying, pre-sorting, opening, date stamping, batching, and routing of all incoming business correspondence for professional and institutional HMO claims within established guidelines set forth in the Claims Industry.
Essential Functions: 
  • Sorts, date-stamps, counts and logs HMO claims daily for both scanned/non-scanned claim type, and establishes the designation of the claims received based on specific sorting guidelines that determine the routing for each claim.  TAT same business day as received to ensure compliance with all Health Plans.  Expected accuracy is 95%.
  • Identifies, date stamps, counts, and logs Provider Dispute Resolution, Medical Records and miscellaneous correspondence; prepares manual batches for routing to the appropriate department.  TAT same business day as received to ensure compliance with all Health Plans.  Expected accuracy is 95%.
  • Evaluates accuracy of submitted claims in accordance with CMS Medicare Claims Processing Manual and determines routing of complete and incomplete claims based on Commercial/Senior line of business.  Re-directs claims to appropriate payers or to submitting providers as needed with required additional information form.
  • Researches both members and providers demographic information in IDX to further determine the routing of claims as needed.
  • Records number of claims received on required form and reports figures via email daily to ensure accurate reporting.
  • Acts as back up to the Inventory Control Clerk as needed in efforts to maintain compliance with all Health Plans.
  • Knowledge of HMO billing or claims processing practices within a healthcare organization required.
  • Knowledge of claims forms (CMS1500 and UB04).
  • Knowledge of Industry Compliance Timeframes.
  • Familiarity with the Microsoft windows operating environment.
  • 10-key by touch.
  • Possess basic analytical and problem solving skills.
  • Demonstrate effective written and oral communication skills, ability to follow instructions, interpersonal skills, and organizational ability and work independently.
  • Must be able to work as a team player and have a professional demeanor.
  • Organization and prioritization skills.
  • Knowledge of EOBs, Medical Records, Clean vs. unclean claims, In vs. Out of Network utilization and PDRs, preferred.
  • Knowledge of the CMS Medicare Claims Processing Manual, preferred.
  • A working knowledge of CPT, ICD-9 HCPCS, medical terminology and provider billing, preferred.
Minimum Position Requirements:
Experience: 1 year experience with HMO billing or claims processing practices within a healthcare organization.
Preferred Position Qualifications:
  • 1 year experience with HMO billing or claims processing practices within an IPA, MSO or Health Plan.
  • IDX experience.
Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values. Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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