Claims Examiner
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At a glance
Job overview
HealthcareSupport Staffing is hiring a Claims Examiner. The Claims Examiner will accurately and timely adjudicate claims in accordance with applicable contracts, state and federal regulations, health plan requirements, policies, and procedures. This role involves analyzing professional and hospital claims for accuracy, reviewing authorizations and provider contracts, and ensuring accurate data input for claims adjudication. The ideal candidate will have experience in Managed Care claims.
Key focus areas include Analyze professional and/or hospital claims for accuracy according to set dollar thresholds, Meet and maintain production and quality standards, and Review authorization and/or provider's contract.
Successful candidates bring 1+ Years Managed Care Claims Experience, High School Diploma/GED, and Typing 40-45 WPM. Important skills include ICD9 CM, CPT, HCPCS, RBRVS Coding Schemes, Medical Terminology, and Accurate Data Input.
Skills & qualifications
Skills
Qualifications
Full job description
Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company in the San Fernando, CA area? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!
The ideal person for this position would have 1+ year of Managed Care claims experience. In this role you will be responsible for the accurate & timely adjudication of all claims in accordance with applicable contracts, state & federal regulations, health plan requirements, policies & procedures.
Key Responsibilities:
Analyzes professional &/or hospital claims for accuracy according to set dollar thresholds, meets & maintains production & quality standards
Reviews authorization &/or provider's contract & adjudicates claims accordingly
Accurate input of data is requried for claims adjudication including: diagnostic & procedural coding, pricing schedules, member & provider identification & all other related information is required
Performs any correspondence, follow up & any projects delegated by claims supervisor
Knowledge, Skills & Abilities:
Understanding of health & managed care concepts & their application in the adjudication of claims
Strong working knowledge of ICD9 CM, CPT, HCPCS, RBRVS coding schemes & medical terminology
Minimum Qualifications:
Monday - Friday schedule & competitive pay!
1-3+ year experience processing of managed care health claims
Ability to type 40-45 wpm
Understanding of medical terminology
Must have excellent understanding of health & managed care concepts & their application in the adjudication of claims
Must be able to accurately assess financial responsibility & liability for claims submitted by both members & providers
High School diploma/GED required
Interested in being considered?
If you are interested in applying to this position, please contact Blake Anderson at 407-478-0332 ext. 115 and/or click the Green I’m Interested Button to email your resume
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