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Medical Claims Processor
2 weeks ago
**Description**: JOB TITLE: Claims Examiner - Days
**LOCATION**: 9557 Greenleaf Avenue, Whittier, CA
**SHIFT**: Monday - Friday - 07:00am - 03:30pm
**DURATION**:
- 13 weeks
** 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 non-contracted providers for Letter of Agreement consideration
- Data entry experience
- Training on basic office automation and managed care computer systems
RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONS
**Job Types**: Contract, Temporary
Pay: $25.00 - $26.00 per hour
Expected hours: 40 per week
Schedule:
- 8 hour shift
- Day shift
Work setting:
- Ambulatory surgery center
- Children's hospital
- Hospital
- Military hospital
- Nursing home
- Office
Ability to Relocate:
- Whittier, CA 90601: Relocate before starting work (required)
Work Location: In person
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