What are the responsibilities and job description for the Claims Examiner position at American Recruiters?
Job Title: Claims Examiner
Profession: Finance/Accounting
Location: Whittier, CA
Roles: Multiple, please apply
Pay Package Travel: Weekly Gross: $1140 for 40 hours
Pay Package Local: Gross Pay: $24/hr to $26/hr.
Shift: Days, 5x8, Monday through Friday; 7:00AM-3:30PM
Duration: 13 Weeks
Experience/Must Have:
2 Years’ Experience Required in claims adjudication experience in ambulatory, acute care hospital, HMO, or IPA Environment.
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.
Must Have:
- DOFR
- Processed Lab Claims
- Must be able to verify High School Diploma or Higher Education
Requirements:
- 2 Years’ Experience Required in claims adjudication 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 is desirable.
- Ability to identify non-contracted providers for Letter of Agreement consideration.
- Data entry experience.
- Training in basic office automation and managed care computer systems.
Why Join Us?
We offer a supportive environment where you can make a real difference in the lives of our residents. Join our team and contribute to the success of our facility while advancing your career!
Salary : $24 - $26
