CLAIMS CLERK - Part Time

Come and join the RMC Family!

We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY: Provide clerical support to all areas in the Prepaid Business Services Department. Responsibilities include, but are not limited to, opening, counting, date stamping, sorting by plan type, and batching mail daily. Verification of patient eligibility, patient account updates and reviews of various member eligibility reports. Enter Commercial claims in the claims system for "Acknowledgement" purposes, within 15 working days from receipt, as outlined in Title 28, Section 1300.71 and 1300.71.38 of the California Code of Regulations, or AB1455.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and within the established time allowance. 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.

EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED). Clerical and medical office experience preferred.

CERTIFICATES, LICENSES, AND REGISTRATIONS: None.

ESSENTIAL FUNCTIONS:
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).

1. Open, count, sort, date stamp claims by plan type, batch and file mail daily.

2. Using computer, type patient information necessary to identify patient account.

3. Handwrite the patient account and internal HMO insurance code on every claim received, before it is batched and filed.

4. Data enter in the computer, all Commercial claims received within 15 working days of receipt, prior to batching and filing.

5. Notify the Claim Supervisor daily of all claims received which have multiple date stamps on the claim.

6. Manually count all claims on hand every Monday morning and send the inventory report to the Manager via email.

7. Maintain the daily in-coming mail count and on the claims hand log and submit to the Manager every Monday.

8. Assist the Claim Supervisor with distribution of claims to the examiners for processing.

9. Enter every batch distributed in the "Batch Control" Access database for tracking purposes.

10. Verifies health plan coverage and updates patient insurance record in computer. Any patients found ineligible at time of service will be turned over to the FFS Business Office for handling.

11. Assists the Team Leader with verification of eligibility when the Claims Examiners are unable to process a claim. Update insurance record in computer based on information found from the health plans.

12. In the absence of the Administrative Assistant, assist the Manager with member denial letter preparation, copying, mailing and logging in the "Retro Claims" database.

This opportunity offers the following:

Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.