Non-Clinical - Finance / Accounting - Claims Examiner

Must have listed claims reimbursement experience Must have DOFR Must have processed lab claims

• Will Need References to Submit.
• Will Need References to Submit.
• Will Need References to Submit.
• ONSITE INTERVIEW REQUIRED
• JOB TITLE : Claims Examiner Days LOCATION : 9557 Greenleaf Avenue, Whittier, CA SHIFT : Monday - Friday - 07 : 00am - 03 : 30pm PLEASE NOTE ORIENTATION TIME MAY DIFFER THAN SHIFT TIMES LISTED DURATION - 13 weeks
• 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION
• POSITION SUMMARY : 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. Must have physical proof on hand if background check is unable to verify your education background. 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 RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONS