Claims Processor

3 weeks ago

Whittier, United States vTech Solution Full time
  • Status: Open
  • Union Code:
  • Profession:
    Non-Clinical - Finance/Accounting
  • Specialty: Claims Processor
  • Unit: Claims Examiner/ 110-85300
  • Shift: Day 5x8-Hour (07:00 - 15:30)
  • Block Schedules: No
  • Start Date: 04/01/2024
  • Job Duration:13
  • # of Positions: 1
  • Non-Bill. Orientation:
  • Overtime Multiplier: 8 regular hours in a day AND 40 regular hours in 1 week : 1.5%
  • Double Time Multiplier: 12 total hours in a day : 2%
  • Charge Nurse: None
  • On Call: None
  • Call Back: None
  • Holiday: 1.5%
  • Observed Holidays:

    New Year's Day: Falls Within: 7:00 PM day before - 7:00 AM day after

    Labor Day: Falls Within: 7:00 PM day before - 7:00 AM day after

    Independence Day: Falls Within: 7:00 PM day before - 7:00 AM day after

    Memorial Day: Falls Within: 7:00 PM day before - 7:00 AM day after

    Thanksgiving: Falls Within: 7:00 PM day before - 7:00 AM day after

    Christmas: Falls Within: 7:00 PM day before - 7:00 AM day after

    Holiday Comments: None
  • Orientation:
    All Hours Billable
  • Job Location:
    9557 Greenleaf Avenue
    Whittier, CA 90601
  • 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

    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

    RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONS

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