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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing, including ICD-9/ICD-10 and CPT coding, while ensuring data integrity and compliance with quality standards such as HEDIS and NCQA. Strong organizational and communication skills support effective training and auditing processes.
Highest-signal resume keywords
Claims Processing ExperienceICD-9/ICD-10 CodingCPT CodingQuality Auditing ToolsMedicare/Medi-Cal Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingICD-9 CodingICD-10 CodingCPT CodingData EntryQuality AuditingManaged Care ExperienceMicrocomputer SkillsWindows Applications Proficiency
Soft Skills
Excellent Communication SkillsInterpersonal SkillsStrong Organizational SkillsProfessional Demeanor
Tools & Technologies
WebstratOptumCMS Pricing
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
HEDISCAHPSNCQA Accreditation
About the role
Key responsibilities & impact- Ensure the integrity of all data created and updated by Claims Processing staff
- Utilize quality auditing tools
- Identify training needs
- Define effective and efficient methods for accurate data entry and adjudication
- Incorporate IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation
- Work under the direction of the Claims Quality Assurance Manager and Supervisor
Requirements
What you’ll need- Two (2) years of experience in examining and processing institutional and professional claims
- Medicare/Medi-Cal experience preferred
- Experience in a managed care environment helpful
- High school diploma or GED required
- ICD-9/ ICD-10 and CPT coding and general practices of claims processing
- Familiarity of Webstrat, Optum and CMS pricing
- Excellent communication and interpersonal skills
- Strong organizational skills
- Microcomputer skills
- Proficiency in Windows applications preferred
- Professional demeanor
Benefits
Comp & perks- Competitive salary
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance