What are the responsibilities and job description for the Medical Claims Examiner position at Robert Half?
A Healthcare Organization in Mid-Wilshire is looking for a Medical Claims Examiner. The Medical Claims Examiner will be responsible for processing, examining, adjudicate and adjust claims . The Medical Claims Examiner will also be responsible for the monitoring of claims to ensure compliance with the Summary Plan Description, Federal and State Mandates, and Quarterly updates as dictated by the Board of Trustees. Key Responsibilities• Generate and utilize claims adjudication reports for identifying claims adjudication errors• Process, examine and adjudicate claims• Facilitate and track the correction of claim adjudication errors• Maintain knowledge of all ICD 10, CPT, HCPCS codes, general billing procedures for Health Care Payers• Test and audit claims payments for accuracy on pre and post payments• Release Held Audits claims for accuracy and consistency• Maintains detailed knowledge & understanding of claims payments• Compile individual’s Audit results to deliver to the Manager• Maintain and update of Claims Manual Processing Guide utilized by the Claims Department• Perform other duties as necessary or assigned by the Claims Manager or Administrative Manager• Maintain required levels of production and quality standards as established by Claims Manager
Salary : $25 - $29
