- Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits, i.e. co-payment, deductible, etc.
- Review and process facility (UB-04) and professional claims (CMS
- 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 report.
- Maintain quality and productivity standards, teamwork, and comply with company/administrative guidelines.
- Ensures compliance with all applicable Federal, State and/or County laws and regulations related to our documented guidelines and processes.
- Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
- Maintains regular and consistent attendance.
- Adheres to Compliance Plan and HIPAA regulations.
- Takes on special projects as needed.
- Performs other duties as assigned.
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Claims Examiner Iii
1 week ago
Advanced Medical Management, Inc. Long Beach, United States**Claims Examiner III** · **Role Insights** · **Primary Responsibilities** · - Audit claims processing quality, develops, maintains and runs standard reports · - Assist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural) ...
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Claims Examiner Iii
1 week ago
TRISTAR RISK MANAGEMENT Signal Hill, United States**This position requires the employee to be bilingual English/ Spanish.** · ***:Under mínimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. · This position requires considerable interaction w ...
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Claims Examiner III
1 week ago
Astrana Health Monterey Park, United States· Job Title: Claims Examiner III · Department: Operations - Claims · About the Role: · We are currently seeking a highly motivated Claims Examiner. This role will report to the Manager - Claims and enable us to continue to scale in the healthcare industry. · What You'll Do: ...
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Claims Examiner III
1 week ago
Tristar Insurance Services LLC Signal Hill, United StatesJob Details · Level · Experienced · Job Location · Signal Hill Office - Signal Hill, CA · Remote Type · Fully Remote · Position Type · Full Time · Education Level · High School Diploma or GED · Salary Range · $85, $95,000.00 Salary/year · Travel Percentage · None · ...
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Claims Examiner II/III
2 weeks ago
Innovative Management Systems Incorporated Bassett, United States:We are looking for a Claims Examiner II/III, depending on their knowledge and experience. This position is not an entry level position and will need to fully understand Medicare claims processing specifically in a managed care organization, managed service organization, IPA, and ...
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Claims Examiner II/III
2 weeks ago
Innovative Management Systems Incorporated Bassett, United States:We are looking for a Claims Examiner II/III, depending on their knowledge and experience. This position is not an entry level position and will need to fully understand Medicare claims processing specifically in a managed care organization, managed service organization, IPA, and ...
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Claims Examiner II/III
2 weeks ago
Innovative Management Systems Incorporated CITY OF INDUSTRY, CA, US, United States Full time:We are looking for a Claims Examiner II/III, depending on their knowledge and experience. This position is not an entry level position and will need to fully understand Medicare claims processing specifically in a managed care organization, managed service organization, IPA, and ...
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Claims Examiner II/III
5 days ago
Innovative Management Systems Incorporated La Puente, United StatesJob Description · Job DescriptionDescription:We are looking for a Claims Examiner II/III, depending on their knowledge and experience. This position is not an entry level position and will need to fully understand Medicare claims processing specifically in a managed care organiza ...
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Claims Examiner II/III
1 week ago
Innovative Management Systems, Inc. La Puente, United StatesJob Type · Full-time · Description · We are looking for a Claims Examiner II/III, depending on their knowledge and experience. This position is not an entry level position and will need to fully understand Medicare claims processing specifically in a managed care organization, ...
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Claims Examiner II/III
3 weeks ago
Innovative Management Systems Incorporated La Puente, United States: We are looking for a Claims Examiner II/III, depending on their knowledge and experience. This position is not an entry level position and will need to fully understand Medicare claims processing specifically in a managed care organization, managed service organization, IPA, an ...
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Medical Claims Examiner III
6 days ago
Ultimate Staffing Long Beach, United StatesParameters of the provider's contract obligations. Audit claims processing quality, develops, maintains and runs standard reports. Assist the Claims Supervisor/ Director in reviewing the quality auditing tracking/reporting (financial and procedura Medical, Examiner, Claims, Claim ...
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Medical Claims Examiner III
2 weeks ago
Ultimate Staffing Long Beach, United StatesJob Responsibilities: · Manage and ensure compliance with provider contract obligations. · Conduct quality audits of claims processing, including generating and maintaining standard reports. · Collaborate with the Claims Supervisor/Director to assess auditing tracking and reporti ...
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Medical Claims Examiner III
6 days ago
Ultimate Staffing Services Long Beach, United StatesJob Description · Job DescriptionResponsibilities: · Parameters of the provider's contract obligations. · Audit claims processing quality, develops, maintains and runs standard reports · Assist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (f ...
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Workers Compensation Claims Examiner III
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Tristar Insurance Services LLC Signal Hill, United StatesJob Details · Level · Experienced · Job Location · Signal Hill Office - Signal Hill, CA · Remote Type · Fully Remote · Position Type · Full Time · Education Level · High School Diploma or GED · Salary Range · $85, $95,000.00 Salary/year · Travel Percentage · None · ...
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Procom Long Beach, United States(Workers Compensation Claims Examiner Level III) Intro · Our client, the largest privately held third party claims administrator in the United States, is seeking a Workers Compensation Claims Examiner Level III. The ideal candidate will have a minimum of 5 years of experience in ...
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Financial Institutions Examiner
6 days ago
Department of Financial Protection and Innovation Los Angeles, United States**About the DFPI** · The Department of Financial Protection and Innovation (DFPI) is California's financial regulator, working to protect consumers by examining and licensing financial activities and taking action against unfair, deceptive, or abusive practices. We oversee state- ...
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Deputy Attorney General Iv
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Department of Justice Los Angeles County, CA, United StatesDeputies in the Appeals, Writs and Trials section of the Criminal Law Division handle felony criminal appeals and related writs, including those in death penalty cases, before the state courts of appeal and the California Supreme Court. Deputies also respond to habeas corpus liti ...
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Unarmed Guard
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Savage III, Inc. Los Angeles, United States**Security Guard (Unarmed) - Greater Los Angeles Area** · **Savage III, Inc. - Greater Los Angeles Area** · **UNARMED SECURITY GUARD** · **Savage III, Inc. - Executive Protective Agency - Los Angeles & Surrounding Area** · **Who We Are** - Savage III, Inc. is an elite executive p ...
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Supply Officer I
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Los Angeles County Department of Human Resources Los Angeles County, CA, United States**EXAM NUMBER**: · - PH2373B**TYPE OF RECRUITMENT**: · OPEN COMPETITIVE JOB OPPORTUNITY · **FILING DATE**: · Tuesday, May 14, 2024 at 8:30 a.m._,_ Pacific Time (PT)**DEFINITION**: · - Has comprehensive responsibility for supply and related functions in a large department. · - **C ...
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Grounds Maintenance Worker I, Preparing Los Angeles
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Los Angeles County Department of Human Resources Los Angeles County, CA, United States**EXAM NUMBER** · R0352E-R · - **APPLICATION FILING PERIOD** · **This exam will reopen as the needs of the service require.** · **TYPE OF RECRUITMENT** · Open Competitive Job Opportunities · **JOB TYPE**: · - Permanent and Temporary (As Needed)**DEFINITION**: · Performs routine a ...
Claims Examiner III - Pasadena, United States - Imperial Health Plan of California, Inc.
Description
JOB SUMMARY: Is responsible for adjudicating complex claims which include high dollar claims. Responsible for accurate manual/auto pricing of claims. Identify provider billing issues that impact claims processing. Works closely with the Supervisor to identify any reporting or training needs and system problems that may be encountered. Maintains quality and production standards, teamwork and comply with company/administrative policies and guidelines.
ESSENTIAL JOB FUNCTIONS:
MARGINAL JOB FUNCTIONS:
