Claims Examiners
Los Angeles, CAFull-timePosted 11y agoStill listed 5 days ago
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Job overview
HealthcareSupport Staffing is hiring a Claims Examiners. The Claims Examiner is responsible for the accurate and timely adjudication of all claims, adhering to applicable contracts, state and federal regulations, and health plan requirements. Examiners are expected to maintain high coding and financial accuracy, process a minimum number of claims per hour, and effectively manage pended items to meet timeliness requirements for various product lines.
Key focus areas include Reports to the Director of Claims, Responsible for the accurate and timely adjudication of all claims, and Produce a minimum of 30 claims per hour.
Successful candidates bring HS/Diploma Or GED/Equivalent, 1-3+ Years Of Processing Managed Care Health Claims, and 3+ Years Of Experience Working On Managed Care Claims. Important skills include Accurate And Timely Adjudication, Coding Accuracy, Financial Accuracy, Managing Pended Items/Claims, Medical Terminology, and Ten Key By Touch.
Skills & qualifications
Skills
Qualifications
Full job description
Company Job Description/Day to Day Duties:
-Reports to the Director of Claims
-Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements
-Examiners are expected to produce a minimum of 30 claims per hour.
-Examiners are expected to maintain 98 percent coding and financial accuracy.
-Examiners must meet timeliness requirements for the product line(s) they are responsible for processing. This can be achieved by effectively managing pended items/claims on a daily basis (working them at least two times a day) and by meeting daily production goals.
A. Medicare- 30 calendar days regardless of provider contract status.
B. Medi-Cal- 30 calendar days regardless of provider contract status.
C. Commercial- 60 calendar days regardless of provider contract status.
Minimum Education/Licensures/Qualifications:
-HS/Diploma or GED/equivalent
-1-3+ years of processing of managed care health claims
-Strong knowledge of medical terminology
-Strong Ten Key by touch
-Ability to type at least 40- 45 wpm (if they are unsure of typing skills, please send prove it!)
-Proficient with Microsoft Office/General office equipment experience (i.e. photocopier, fax, calculator, ability to operate a PC)
-Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes
-Experience with different software and hardware systems for claims adjudication
-Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims.
-Must be able to accurately assess financial responsibility and liability for claims submitted by both members and providers.
-Accurate input of data is required for claims adjudication including: diagnostic and procedural coding, pricing schedules, member and provider identification, and all other related information as required.
Best Candidate: 3+ years of experience working on Managed Care claims
2nd Best: 1+ year experience as a Claims Examiner
Location:
15821 Ventura Blvd suite 600
Encino, CA 91436
If Contract, Length of Assignment: RTH
Shift: Monday-Friday, 8am-5pm (There is a night shift, but as of now they are not looking to fill any night spots- if you have a candidate seeking a later shift, I am happy to present them)
Start Date: As soon as all HR is back and clear
Times/Interviewer: Phone interviews with hiring manager- Laura Saez, Claims Supervisor- possible for same day scheduling if not as soon as next day
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