Claims Examiner
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Job Location:
Whittier, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
3 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Title: Claims Examiner
Location: Whittier CA 90601
Duration: 13 weeks / 3 Months
Shift: Day Shift Monday Friday 07:00 AM - 03:30 PM
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
Key Skills
- Auditing
- GAAP
- Military Experience
- Phlebotomy
- Conflict Management
- Vital Signs Experience
- Computer Forensics
- Research Experience
- Securities Law
- Operating Systems
- PTSD Care
- RMF
