Claims Examiner II

4 days ago


Fairfield, California, United States Yoh Full time
Job Title: Claims Examiner II

Yoh is seeking a skilled Claims Examiner II to join our team in Redding, CA. As a Claims Examiner II, you will be responsible for reviewing, researching, and resolving pended claims for Medi-Cal types, including medical, ancillary, long-term care, CHDP, encounter data, other coverage, and batch claims.

Key Responsibilities:
  • Review and resolve pended claims within established production and quality standards.
  • Route claims to appropriate departments and internal staff for additional review.
  • Follow up and complete claims once response to request has been received.
  • Follow established policies and procedures, Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims.
  • Generate claims correspondence as needed.
  • Record daily production statistics and related activities on appropriate reports.
  • Review all work audits in a timely manner and submit any adjustments and corrections within the allotted time frame.
  • Support Claims Department's needs for resolving all pended claim types.
  • Participate in special projects and assignments as required.
  • Identify and report trends of pending claims that are increasing or processes that appear dated.
  • Recognize and give feedback to management on procedure changes that would result in more efficient operations.
Requirements:
  • High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment.
  • Effective written and oral communication skills. Good organization skills.
  • Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred.
  • Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy.
  • Ability to stay focused on repetitive work and meet production and quality standards.
  • Ability to accurately complete tasks within established timelines.
  • Consistently meets production standards without compromising quality on all tasks.
  • Ability to use a microcomputer keyboard. More than 95% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.
What We Offer:
  • Medical, Dental & Vision Benefits
  • 401K Retirement Saving Plan
  • Life & Disability Insurance
  • Direct Deposit & weekly EPayroll
  • Employee Discount Programs
  • Referral Bonus Programs

Yoh is an Equal Opportunity Employer and welcomes all qualified applicants to apply. Please visit our website to contact us if you are an individual with a disability and require accommodation in the application process.



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