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Medical Claims Examiner

1 month ago

Long Beach, California, United States Ultimate Staffing Full time
Job Summary

We are seeking a highly skilled Medical Claims Examiner to join our team at Ultimate Staffing. As a Medical Claims Examiner, you will be responsible for reviewing and processing medical claims, ensuring accuracy and compliance with industry guidelines.

Key Responsibilities
  • Review and process medical claims, including professional and facility claims
  • Audit claims processing quality and develop reports to identify areas for improvement
  • Assist the Claims Supervisor/Director in reviewing quality auditing tracking and reporting
  • Coordinate with various departments to resolve disputes or issues
  • Maintain the Claims department workflow and ensure efficient processing of claims
  • Review and process hospital claims and complicated claims to assist claims examiners
  • Ensure quality claims processing, including inpatient and outpatient hospital claims, Medi-cal, Commercial, and Medi-care claims
  • Review auto adjudication of claims and carve-outs in the Division of Financial Responsibility (DOFR)
  • Prepare reports and work with management and claims unit to improve processes
  • Assist with training and supporting the claims team and recommend process improvements
Requirements
  • High School Diploma or GED, some college preferred
  • 3-5 years of claims examiner experience processing professional and facility claims
  • Strong analytical and problem-solving skills
  • Knowledge of industry guidelines for all LOBs, medical terminology, CPT, Revenue codes, ICD-10, Medicare and Medi-Cal claims adjudication
  • Proficient with Microsoft Office (Word, Excel, Outlook)
Desired Skills and Experience
  • 3-5+ years of Medical Claims Examiner II/III or Specialist experience
  • Experience with EZ-Cap and Encoder Pro preferred

Ultimate Staffing is an equal opportunity employer and welcomes applications from all qualified candidates. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws.