Claims Examiner III

Description

Job Title : Claims Examiner III

Department : Ops - Claims Ops

What You'll Do

• Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure / revenue and ICD-10 codes, under the correct provider and member benefits
• Review and process facility (UB-04) and professional claims (CMS-1500)
• Process claims based on contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups’ and company policies and procedures
• Process Medicare member claims based on DMHC and DHS regulatory legislature
• Respond to and resolve provider and health plan claims inquiries and give resolution in a timely manner
• Review services for appropriateness of charges and apply authorization guidelines during claims processing
• Monitor and track age, pended, and open reports to maintain timeliness in claims processing based on individual work allocation reports
• Maintain quality and productivity standards, teamwork, and comply with company / administrative guidelines
• Participate in special projects, complete tasks assigned by management and attend meetings / conference calls as necessary
• Loading and entering claims
• Other duties as assigned

Qualifications

presentations skills

Environmental Job Requirements and Working Conditions

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information :

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.