Medical Claims Processor

3 weeks ago

Whittier, United States Alpha Pro Full time

**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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