JOB TITLE : Claims Examiner - DaysLOCATION : 9557 Greenleaf Avenue, Whittier, CASHIFT : Monday - Friday - 07 : 00am - 03 : 30pm 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
Non-Clinical - Finance/Accounting/Billing Analyst
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