More jobs:
Claims Examiner
Job in
Whittier, Los Angeles County, California, 90607, USA
Listed on 2026-03-08
Listing for:
Accede Solutions Inc (accedesolution.com)
Full Time
position Listed on 2026-03-08
Job specializations:
-
Healthcare
Healthcare Administration, Medical Billing and Coding, Healthcare Management, Healthcare Compliance
Job Description & How to Apply Below
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.
Requirements- 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER
- 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.
- Ability to identify non-contracted providers for Letter of Agreement consideration.
- Training on basic office automation and managed care computer systems.
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