Claims Processor

Job Title: Claims Processor

Location: Whittier CA 90601

Shift: 07:00am to 15:30pm Monday through Friday

Duration: 3 months

Job Description:

• The claims examiner reports directly to the claims manager.
• They are primarily responsible for the processing functions (operation adjudication and payment) of UB92 and HCFA1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.

Required qualifications:

• High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.
• Minimum of 2 years claims ADJUDICATION related experience in ambulatory acute care hospital HMO or IPA environment.
• Knowledge of payment methodologies for: Professional (MD) Hospital Skilled Nursing Facilities and Ancillary Services
• Knowledge and understanding of timeliness and payment accuracy guidelines for commercial senior and MediCal claims.
• Knowledge of compliance issues as they relate to claims processing.
• Experience in interpreting provider contract reimbursement terms desirable.
• Ability to identify noncontracted providers for Letter of Agreement consideration.
• Data entry experience
• Training on basic office automation and managed care computer systems