Lead Claims Examiner of Production Unit, Claims, Full-Time, Days

Whittier, CA - USA

Monthly Salary: USD 23 - 39

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

The Lead Claims Examiner of the Production Unit is responsible for ensuring that all designated employees are provided their daily assignment of claims ensuring compliance with timeliness of payment by assigning oldest dates first and by line of business. The Lead Claims Examiner will also serve as back up to the Claims Supervisor when not onsite by answering claims examiners questions. The Lead Claims Examiner will also assist by processing medical claims in an efficient cost-effective and timely manner. Responsible for meeting all required guidelines and performing adjustments as necessary including special addition they will serve as back up to the other Leads in the department when necessary and will report directly to the Claims Supervisor.

PIH Health is a nonprofit regional healthcare network that serves approximately 3 million residents in the Los Angeles County Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital PIH Health Good Samaritan Hospital PIH Health Whittier Hospital 37 outpatient medical office buildings a multispecialty medical (physician) group home healthcare services and hospice care as well as heart cancer digestive health orthopedics womens health urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nations top hospital systems for best practices cutting-edge advancements quality of care and healthcare technology. For more information visit follow us on Facebook Twitter or Instagram.

Required Skills

Knowledge of claims regulatory timeframes/timeliness of payment.
Full understanding of HMO & capitation concepts and Medicare guidelines;
Extensive knowledge of facility ancillary and professional claims
Knowledge of medical terminology & RVS/CPT/RBRVS/ICD-10 codes.
Experienced with provider contract payment methodologies including but not limited to case-rates and stop-loss.
Excellent communication problem solving and decision-making skills coupled with the ability to work successfully in a team environment.

Required Skills

Knowledge of claims regulatory timeframes/timeliness of payment.
Full understanding of HMO & capitation concepts and Medicare guidelines;
Extensive knowledge of facility ancillary and professional claims
Knowledge of medical terminology & RVS/CPT/RBRVS/ICD-10 codes.
Experienced with provider contract payment methodologies including but not limited to case-rates and stop-loss.
Excellent communication problem solving and decision-making skills coupled with the ability to work successfully in a team environment.