SHIFT: Monday - Friday - 07:00am - 03:30pm Duration: 13 weeks
Job description:
The claims examiner reports to the claims manager and is responsible for processing UB-92 and HCFA-1500 claims from PHP-affiliated medical groups and hospitals for HMO patients.
Qualifications:
- Minimum of 2 years experience in claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment
Candidate Requirements:
(must pass a Background Check, Health Screening + Drug Test)
Skills:
- High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background.
- 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: Full-time
Pay: From $27.00 per hour
Expected hours: 40 per week
Benefits:
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Ability to Relocate:
- Whittier, CA 90601: Relocate before starting work (Required)
Work Location: In person