Claims Examiner

Job Description

Intro:

Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you have claims adjudication or facility claims experience in healthcare? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

• Conducts claims payment analyses to identify root cause of claims issues/deficiencies.
• Adjudicates medical claims
• Verifies patient account, eligibility, benefits and authorizations.
• Prioritizes assigned claims according to regulatory timelines.
• Requests additional information for incomplete or unclean claims; follows up with provider as necessary.
• Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes.
• Corresponds with IPAs/Medical Groups regarding misdirected claims.

Requirements:

• 2-5 years medical claims examining experience,
• Minimum typing speed of 45 WPM and use of Ten-Key by touch
• Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus
• Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements

If you are interested, PLEASE CONTACT Tyler AT  EXT 117