Claims Examiner

Must have listed claims reimbursement experience
Must have DOFR
Must have processed lab claims

** 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