Medical Claims Examiner - Whittier, United States - The Principle Group

The Principle Group

Verified Company

Whittier, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

Description:

JOB TITLE:
Claims Examiner - Days

LOCATION: 9557 Greenleaf Avenue, Whittier, CA

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

DURATION - 13 weeks(extend)

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