Claims Representative - Whittier, United States - PIH Health Physicians

Description

JOB TITLE:
Claims Examiner - Days




LOCATION:
9557 Greenleaf Avenue, Whittier, CA




SHIFT:
Monday - Friday - 07:00am - 03:30pm

DURATION - 13 weeks

2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION
***: 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 noncontracted providers for Letter of Agreement consideration
• Data entry experience
• Training on basic office automation and managed care computer systems

Job Type:
Contract


Pay:
$25.00 per hour


Benefits:

• 401(k)
• 401(k)

matching

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• Inperson

Experience:

- claims examiner: 3 years (required)


Work Location:
In person