Claims Examiner 2-Managed Care

- Managed Care (Full-Time, Day Shift) -

Our mission is to participate in Jesus Christ’s ministry, bringing health, healing, and wholeness to humanity by: Creating a supportive faculty practice framework that allows Loma Linda University School of Medicine physicians and surgeons to educate, conduct research, and deliver quality health care with optimum efficiency, deploying a motivated and competent workforce trained in customer service and whole person care principles and providing safe, seamless and satisfying health care encounters for patients while upholding the highest standards of fiscal integrity and clinical ethics. Our core values are compassion, integrity, humility, excellence, justice, teamwork and wholeness.

This Claims Examiner 2-Mgd Care will process professional and hospital HMO Risk claims in accordance with the individual provider contracts in an accurate and timely manner, verify system assigned risk pool determination in accordance with HMO Division of Financial Responsibility matrix, initiate check run, perform standard reporting, ensure audit readiness, and process third party claims. Performs other duties as needed.

High School Diploma or GED required. Bachelor’s Degree in Computer Science, Business, or similar degree preferred. Minimum five years managed care claims processing experience with professional claims and institutional claims.

Knowledge of Microsoft Office Suite. Must be well versed in medical terminology, CPT, and ICD9/10 coding guidelines. Comprehensive understanding of institutional inpatient and outpatient hospital claims processing, DRG’s and all other institutional calculation standards. Comprehensive understanding of professional claims adjudication process. Understanding of the Managed Care health care delivery system. Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.Certified Professional Coder preferred. Valid Driver’s License at time of hire.