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Job Title: - Claims Examiner
Job Location: - 6557 Greenleaf Avenue Whittier, CA 90601
Job Duration: 3+ months (Temp to Perm)
Pay Range: $31 to $31.10/Hr. on W2
Shift 1st Day 5x8-Hour (07:00 AM - 03:30 PM)
Job Description
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
- 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
Job Type: Contract
Salary: $31.00 - $31.10 per hour
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Ability to commute/relocate:
- Whittier, CA 90601: Reliably commute or planning to relocate before starting work (Required)
Experience:
- claims ADJUDICATION: 2 years (Preferred)
- Knowledge of payment methodologies: 1 year (Preferred)
- UB-92: 1 year (Preferred)
- HCFA-1500 claims: 1 year (Preferred)
- Medi-Cal claims: 1 year (Preferred)
Work Location: In person
