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Claims Examiner
1 month ago
Thrifty Management Services, the dedicated MSO for Preferred IPA of California, seeks a skilled Claims Examiner to join their team. As a Claims Examiner, you will play a critical role in ensuring the accurate and timely adjudication of paper and/or electronically formatted claims received in the CMS 1500 and/or UB-04 format.
Key Responsibilities:
- Process claims and applicable claims correspondence in accordance with Medicare and Medi-Cal regulatory guidelines, contract provisions, and established policies and procedures.
- Meet accuracy and productivity targets outlined in the department's performance standards.
- Utilize strong knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines to ensure accurate claims processing.
- Work independently to analyze claims and make informed decisions regarding claim status.
- Interact effectively with providers, employees, and supervisors to ensure seamless communication and collaboration.
- Stay up-to-date with changing regulations and guidelines to ensure compliance and accuracy in claims processing.
Requirements:
- Minimum of 4 years medical claims payment experience in an HMO environment.
- Strong knowledge of CPT-4, ICD-10CM, RBRVS, ASA, and HCPCS, as well as in-depth understanding of Medicare and Medi-Cal guidelines.
- Extensive familiarity with plan benefit and co-payment determination, division of financial responsibility determination, claims policies and procedures, and adjudication processes.
- Intermediate computer skills, including Microsoft Word, Excel, and Internet navigation.
About Thrifty Management Services:
Thrifty Management Services is dedicated to providing high-quality care management, care coordination, and claims processing services to Preferred IPA and their members. We work closely with participating physicians to coordinate patient care and provide superior healthcare to our members.
