Claims Processor
2 months ago
Description: JOB TITLE: Claims Examiner - Days
LOCATION: 9557 Greenleaf Avenue, Whittier, CA
SHIFT: Monday - Friday - 07:00am - 03:30pm
** 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
- COVID-19 Vaccine (Facility Guideline):Required + Booster
**Job Type**: Contract
Pay: $25.00 - $27.28 per hour
Schedule:
- Monday to Friday
Application Question(s):
- Any work experience in ambulatory?
**Experience**:
- claims ADJUDICATION: 3 years (preferred)
- acute care hospital: 3 years (preferred)
Work Location: On the road
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