Medical Claims Specialist - Whittier, United States - Binding Minds

Binding Minds
Binding Minds
Verified Company
Whittier, United States

1 week ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

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  • The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB92 and HCFA1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
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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

Expected hours: 40 per week


Schedule:

  • 8 hour shift
  • Day shift
  • Monday to Friday

Work setting:

  • Inperson

Experience:

Medical Claims: 2 years (required)


Work Location:
In person
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