About Path of Life Ministries

Path of Life Ministries is a 501c3 organization serving those experiencing homelessness in the greater Riverside area. Our strategy is to provide a holistic system of care in an integrated, seamless manner to individuals and families, leading them from a place of crisis to a life of stability and self-sufficiency. Our goal is to walk people home. We seek talented and compassionate individuals able to thrive in a high-capacity and complex landscape of providing human services in a non-profit setting.

Position Overview:

This Claims Processor provides support to our Enhanced Care Management team (ECM).  The ECM team offers care management to POLM program participants who are also IEHP members. This service is a Medi-Cal benefit offered to those with complex needs. With whole person care principles employed, the integrated care team works with IEHP members and their families, as well as health care and community partners, to coordinate seamless access to health services. The Claims Processor is responsible for all aspects of claim preparation, processing, and follow-up for this the ECM service.

Essential Functions

• Responsible for non-delegated provider claims verification and adjudication

• Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications

• Meet Regulatory Compliance Regulations on turnaround times and claim payments

• Read and interpret Medi-Cal/Medicare Fee Schedules

• Must be able to make a sound determination if claim is eligible for payment or denial

• Interface with other IEHP Departments, when necessary, regarding claims issues

• Responsible for meeting the performance measurement standards for productivity and accuracy

• Any other duties as required to ensure the Health Plan operations are successful

Education and Qualifications:

• Two (2) years of experience in adjudicating outpatient professional and/or institutional claims

• One (1) year of experience in medical billing is preferred

• Medicare, Medi-Cal, or Commercial claims required

• Experience in an HMO or Managed Care setting preferred

• Claim adjustments, provider appeals and/or disputes preferred

• Microcomputer skills, proficiency in Windows applications preferred

• Excellent communication and interpersonal skills, strong organizational skills

• High School Diploma or GED required

Physical & Mental Demands:

• Ability to multi-task and stay focused with many interruptions

• Ability to stay composed in difficult situations

• Working at desk for extended periods of time

• Lifting and carrying up to 25 lbs. for short distances