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    Claims Examiner - Whittier, United States - E-Solutions IT Services Private Limited

    E-Solutions IT Services Private Limited
    E-Solutions IT Services Private Limited Whittier, United States

    3 weeks ago

    Default job background
    Description
    *MUST HAVE:

    • 1. 2+ years of Claims ADJUDICATION experience |
    • 2. 1+ years experience working as a claims examiner |
    • 3. Experience in ambulatory, acute care hospital, HMO, or IPA environment |
    • 4. 3+ years experience in a CoC-accredited site and are versed in California requirements
    • 5. Need someone who makes a final decision after examining the claim about whether to pay for the claim or deny the claimJob Description:
    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 a background check is unable to verify your educational 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 non-contracted providers for Letter of Agreement consideration
    Data entry experience
    Training on basic office automation and managed care computer systems

    IND_NIT


    Job Type:
    Contract


    Pay:
    $ $28.00 per hour


    Work setting:

    • In-person

    Ability to Commute:

    • Whittier, CA Required)

    Ability to Relocate:

    • Whittier, CA 90601: Relocate before starting work (Required)

    Work Location:
    In person
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