Non-Clinical FinanceAccounting Claims Examiner
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Job Location:
Whittier, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
4 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Summary:
The Claims Examiner is responsible for processing UB-92 and HCFA-1500 claims from affiliated medical groups and hospitals for HMO patients. This includes operation adjudication and payment functions reporting directly to the claims manager.
The Claims Examiner is responsible for processing UB-92 and HCFA-1500 claims from affiliated medical groups and hospitals for HMO patients. This includes operation adjudication and payment functions reporting directly to the claims manager.
Location:Whittier California United States
Responsibilities:
- Process UB-92 and HCFA-1500 claims.
- Perform claims adjudication and payment.
- Identify non-contracted providers for Letter of Agreement consideration.
- Data entry.
- Interpret provider contract reimbursement terms.
- Maintain knowledge of compliance issues related to claims processing.
- Understand timeliness and payment accuracy guidelines for commercial senior and Medi-Cal claims.
- Process UB-92 and HCFA-1500 claims.
- Perform claims adjudication and payment.
- Identify non-contracted providers for Letter of Agreement consideration.
- Data entry.
- Interpret provider contract reimbursement terms.
- Maintain knowledge of compliance issues related to claims processing.
- Understand timeliness and payment accuracy guidelines for commercial senior and Medi-Cal claims.
Required Skills & Certifications:
- High school diploma or GED equivalent.
- Minimum 2 years of claims adjudication experience in ambulatory acute care hospital HMO or IPA environment.
- Knowledge of payment methodologies for Professional (MD) Hospital Skilled Nursing Facilities and Ancillary Services.
- Claims reimbursement experience.
- DOFR (Date of First Receipt) experience.
- Experience processing lab claims.
- High school diploma or GED equivalent.
- Minimum 2 years of claims adjudication experience in ambulatory acute care hospital HMO or IPA environment.
- Knowledge of payment methodologies for Professional (MD) Hospital Skilled Nursing Facilities and Ancillary Services.
- Claims reimbursement experience.
- DOFR (Date of First Receipt) experience.
- Experience processing lab claims.
Preferred Skills & Certifications:
- Experience interpreting provider contract reimbursement terms.
- Experience interpreting provider contract reimbursement terms.
Special Considerations:
- Onsite interview required.
- RTO (Requested Time Off) must be submitted at the time of submittal.
- Onsite interview required.
- RTO (Requested Time Off) must be submitted at the time of submittal.
Scheduling:
- Monday - Friday
- 07:00am - 03:30pm
- Orientation time may differ from shift times listed.
- Duration: 13 weeks
- Monday - Friday
- 07:00am - 03:30pm
- Orientation time may differ from shift times listed.
- Duration: 13 weeks
Key Skills
- Auditing
- GAAP
- Military Experience
- Phlebotomy
- Conflict Management
- Vital Signs Experience
- Computer Forensics
- Research Experience
- Securities Law
- Operating Systems
- PTSD Care
- RMF
