Staffmax is hiring for our client, a leading healthcare Facility in Whittier, CA!
The Claims Examiner, under the direct supervision of the Claims Manager, is tasked primarily with handling the processing aspects (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims originating from PHP-affiliated medical groups and hospitals for HMO patients.
QUALIFICATIONS :
- High school diploma or equivalent required; documentation required if educational background verification is necessary
- 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION
- At least 2 years of experience in claims adjudication within ambulatory, acute care hospital, HMO, or IPA settings.
- Familiarity with payment methodologies for Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services.
- Understanding of timeliness and payment accuracy standards for commercial, senior, and Medi-Cal claims.
- Awareness of compliance issues pertaining to claims processing.
- Experience in interpreting provider contract reimbursement terms is preferred.
- Capability to identify non-contracted providers for consideration of Letter of Agreement.
- Proficiency in data entry.
- Training in basic office automation and managed care computer systems.
COVID-19 Vaccine (Facility Guideline) : Required + Booster - Medical / Religious Exemptions and Declinations Allowed
Flu Vaccine (Facility Guideline) : Required - Medical / Religious Exemptions and Declinations Allowed
Does this sound like a fit for you? Apply Today!
At Staffmax, our sole focus is the recruitment and placement of the most talented and qualified candidates. Whether candidates are looking for a permanent career change or the flexibility and experience that can be gained from contract assignments, we can help.
Our goal is to get to know our candidates personal and change lives. Staffmax is proud to recruit a workforce that reflects the diversity that Canada has to offer.
We encourage candidates who are Indigenous, visible minorities, people with disabilities, and any others who reflect our diverse workforce to self-declare and apply.
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