Claims Mailroom Support Clerk at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Claims Mailroom Support Clerk

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:
The Claims Clerical-Mailroom Support Clerk is responsible for managing incoming mail from providers while ensuring a high level of accuracy. Requires the ability to multi-task while providing accurate and timely mail triaging and processing.

General Duties/Responsibilities:

(May include but are not limited to)

• Responsible for opening, triaging and batching incoming mail, faxes.
• Utilize EZ CAP claim processing system to research provider and member status.
• Data entry of manual claims into EZ CAP claims system.
• Daily logging and counting of mail.
• Responsible for processing daily pend, denial and claim forwarding correspondence.
• Accountable for providing requested documentation to internal departments and provider network (EOB, faxes, scanning, requests for letter copies).
• Support of research projects through claims look-up and simple documentation via Excel spreadsheets.
• Ability to positively support the needs of providers and claims team through professional communication that demonstrates the company culture.
• Participate in Claims Department team meetings and other activities as needed.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in department policies and procedures relating to HIPAA Compliance.
• Other duties and projects as assigned.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum Experience:
   
   
   1. 1 year of mail room/clerical experience in a healthcare setting.
2. Education/Licensure:

1. 
   
   1. High school diploma or general education degree (GED).

1. Other:
   
   
   1. Medicare Claim knowledge-preferred
   2. Ability to multi-task
   3. Ability to remain focused and productive each day through task.
   4. Data entry
   5. Faxing and scanning knowledge preferred
   6. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
   7. Mathematical Skills: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
   8. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
   9. Computer Skills: Knowledge of computer programs and applications required.
   10. Other Skills and Abilities:
       
       
       1. Team player.
       2. Multi-tasking capabilities.

• Good written and verbal communication skills required.

1. Ability to operate a telephone, computer, copier, fax machine, and other office equipment.
2. Ability to travel between locations is essential.

1. Work Environment
2. 
   
   1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. The noise level in the work environment is usually moderate.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
2. The employee is frequently required to reach with hands and arms.
3. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl.
4. The employee must occasionally lift and/or move up to 25 pounds.
5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

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