Senior Claims Adjudication Specialist

1 week ago


Whittier, California, United States APR Consulting Full time

APR Consulting is seeking a highly skilled Senior Claims Adjudication Specialist to join their team in Whittier, California. This full-time contract position offers an attractive compensation package, including a competitive hourly rate of $29.

Job Summary:

The Senior Claims Adjudication Specialist will be responsible for processing and adjudicating claims received from affiliated medical groups and hospitals for HMO patients. The ideal candidate will have at least 2 years of experience in claims adjudication, with knowledge of payment methodologies for Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services.

Key Responsibilities:
  • Process and adjudicate claims in accordance with UB-92 and HCFA-1500 guidelines
  • Review and verify provider information to ensure accurate payment
  • Identify non-contracted providers and recommend Letter of Agreement consideration
  • Provide training on basic office automation and managed care computer systems
Requirements:
  • Bachelor's degree or equivalent required
  • Minimum 2 years of experience in claims adjudication
  • Knowledge of payment methodologies and compliance issues
  • Data entry experience and proficiency in managed care computer systems
Benefits:

This exciting opportunity comes with a range of benefits, including:

  • A competitive hourly rate of $29
  • A comprehensive benefits package, including health insurance, paid time off, and professional development opportunities
  • The chance to work with a leading healthcare staffing provider in the United States


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