Claims Auditor / Claims Processor

Job Title : Claims Auditor / Claims Processor

Location : Whittier, CA

Start Date : (Immediate Start)

Duration : 13 weeks

Schedule Shift : Days | 7 : 00 AM – 3 : 30 PM | 8-hour days | 40-hour guarantee

Pay Rate : $30 / hour

Description :

TITLE : Claims Auditor / Claims Processor

PIH Health Physicians is seeking an experienced Claims Auditor / Claims Processor to support the Claims Department. This role is ideal for professionals with strong medical claims processing experience and knowledge of HMO / IPA operations, Medicare, and Medi-Cal guidelines.

EDUCATION / EXPERIENCE / TRAINING

Required :

High School Diploma or equivalent

Minimum 4 years of medical claims processing experience

Knowledge of :

HMO and / or IPA operations

Medical terminology

ICD-10, CPT, RVS coding

Medicare & Medi-Cal guidelines

Strong 10-key skills (by touch)

Excellent organizational, communication, and time-management skills

Ability to meet deadlines in a fast-paced environment

DUTIES AND RESPONSIBILITIES

Ensure confidentiality of patient protected health information (HIPAA compliant)

Assist the Claims Director with training and education of Claims staff

Coordinate, generate, and review claims audits, pending claims, and status reports

Investigate and process payment adjustments (refunds, overpayments, underpayments)

Serve as a professional resource for providers, members, insurance carriers, and staff

Research and respond to claims-related inquiries in a timely manner

Create and maintain system-generated reports

Support compliance with legal, regulatory, and contractual audit requirements

Prepare and present weekly and monthly quality and performance reports

Review and audit member liability denials and Provider Dispute Resolution claims

Perform additional duties as assigned