Medical Billing Specialist: Claims Examiner

We need to find a Claims Examiner in Sacramento, California! This role is looking for longevity and dedication to joining the team, as well as a love for the industry.

Are you skilled in claim adjudication, submissions, or claim reviews? This role plays an important role in working with the analysis and making sure payments are billed correctly and by contractual agreements.

If this sounds like your passion, please apply today!!

Location : On-Site / Hybrid in Sacramento, CA

Pay : $18-20 / hr

Hours : Full-Time, Monday-Friday

Job Description :

Analyze claims for appropriate payer, based on a combination of coding, medical group’s service area, and contract per the Division of Financial Responsibility (DoFR) document.

Make claim payment determinations.

Process claims, and make payment adjustments as necessary.

Process member reimbursement claims.

Consistently maintain the department audit scores.

Forward misdirected claims to the appropriate payer.

Finalize commercial claims for payment or denial.

Finalize Employee Retirement Income Security Act (ERISA).

Ensure that clean claims are paid within 30 calendar days of receipt.

Qualifications : Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying.

A typical way to obtain the knowledge and abilities would be :

High School Diploma.

1 year experience working with claims adjudication in the health care industry, preferably HMO.

Ability to identify the difference between to International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Revenue (Rev) Codes.

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan.

Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law;

any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Pay Details : $ to $ per hour

Search managed by : Jessica Roberts

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan.

Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs.

In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.