Claims Representative

3 weeks ago

Whittier, United States PIH Health Physicians Full time

**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

**Job Type**: Contract

Pay: $25.00 per hour

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift

Work setting:

- In-person

**Experience**:

- claims examiner: 3 years (required)

Work Location: In person

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