Claims Processor

Job DescriptionJob Description

POSITION SUMMARY:
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 non-contracted providers for Letter of Agreement consideration
• Data entry experience
• Training on basic office automation and managed care computer systems

Company DescriptionAlphaProTemps is specialized in providing "best-in-class" professional staff augmentation services. These recruiting directives include temporary labor, contract sourcing, professional & technical niches, vendor-on-site, and managed service programs.Company DescriptionAlphaProTemps is specialized in providing "best-in-class" professional staff augmentation services. These recruiting directives include temporary labor, contract sourcing, professional & technical niches, vendor-on-site, and managed service programs.

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