Non-Clinical - Finance/Accounting - Claims Examiner
Non-Clinical - Finance/Accounting - Claims Examiner
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
This Claims Examiner position involves processing UB-92 and HCFA-1500 claims for HMO patients from affiliated medical groups and hospitals. The role focuses on claim adjudication payment processing and ensuring compliance with payment accuracy and timeliness guidelines for various claim types. The Claims Examiner reports directly to the Claims Manager.
- Adjudicating claims and ensuring accurate payments.
- Maintaining compliance with payment accuracy and timeliness guidelines for commercial senior and Medi-Cal claims.
- Interpreting provider contract reimbursement terms.
- Identifying non-contracted providers for Letter of Agreement consideration.
- Data entry and utilization of managed care computer systems.
- Maintaining accurate records and documentation.
- Minimum 2 years of claims adjudication experience in an ambulatory acute care hospital HMO or IPA environment.
- Knowledge of payment methodologies for Professional (MD) Hospital Skilled Nursing Facilities and Ancillary Services.
- Understanding of timeliness and payment accuracy guidelines for commercial senior and Medi-Cal claims.
- Knowledge of compliance issues related to claims processing.
- Data entry experience.
- Experience with basic office automation and managed care computer systems.
- Experience with claims reimbursement.
- Knowledge of DOFR (Days Out From Receipt).
- Ability to process lab claims.
- Ability to identify non-contracted providers for Letter of Agreement consideration.
- 13-week contract duration.
- Return-to-office (RTO) required.
- Must be able to verify high school diploma or GED or higher education.
- Orientation time may differ from the listed shift times.
Employment Type
Full-time
