Non-Clinical FinanceAccounting Claims Examiner

Whittier, CA - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

Must have listed claims reimbursement experience Must have DOFR Must have processed lab claims * Will Need References to Submit. * Will Need References to Submit. * Will Need References to Submit. **ONSITE INTERVIEW REQUIRED** JOB TITLE: Claims Examiner Days LOCATION: 9557 Greenleaf Avenue Whittier CA SHIFT: Monday - Friday - 07:00am - 03:30pm PLEASE NOTE ORIENTATION TIME MAY DIFFER THAN SHIFT TIMES LISTED DURATION - 13 weeks *** 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION*** POSITION SUMMARY: The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation adjudication and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients. EDUCATION/EXPERIENCE/TRAINING: 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 Medi-Cal claims * Knowledge of compliance issues as they relate to claims processing Experience in interpreting provider contract reimbursement terms desirable Ability to identify non-contracted providers for Letter of Agreement consideration Data entry experience Training on basic office automation and managed care computer systems RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL NO EXCEPTIONS