Contract role. Contract to hire potential for the right candidate! 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
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
COVID vaccine is required.
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