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Claims Examiner

HealthcareSupport Staffing

Monterey Park, CAFull-timePosted 11y agoStill listed 4 days ago

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At a glance

Compensation
No compensation found
Location
Monterey Park, CA
Schedule
Full-time
Work Authorization
Not specified

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Job overview

HealthcareSupport Staffing is hiring a Claims Examiner. The Claims Examiner conducts claims payment analyses to identify root causes of claims issues and deficiencies. This role involves adjudicating medical claims, verifying patient accounts, eligibility, benefits, and authorizations. The examiner prioritizes claims according to regulatory timelines and requests additional information for incomplete claims, following up with providers as necessary. They also run claims reports to adjudicate adjustments due to retroactive contract or fee schedule changes and correspond with IPAs/Medical Groups regarding misdirected claims.

Key focus areas include Conducts claims payment analyses to identify root cause of claims issues/deficiencies, Adjudicates medical claims, and Verifies patient account, eligibility, benefits and authorizations.

Successful candidates bring 2-5 Years Medical Claims Examining Experience. Important skills include Claims Adjudication, ICD9-CM, HCPCS Level II, HCPCS Level III, CPT, and Revenue Codes. Preferred (not required): DRG Coding.

Skills & qualifications

RequiredNice to have

Skills

Claims AdjudicationICD9-CMHCPCS Level IIHCPCS Level IIICPTRevenue CodesMedi-Cal Payment MethodologiesRBRVS Payment MethodologiesMedicare ReimbursementsDRG CodingAPC Coding

Qualifications

2-5 Years Medical Claims Examining ExperienceTyping Speed 45 WPMTen-Key by Touch

Full job description

Intro:

Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you have claims adjudication or facility claims experience in healthcare? 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!

Daily Responsibilities:

Conducts claims payment analyses to identify root cause of claims issues/deficiencies.

Adjudicates medical claims

Verifies patient account, eligibility, benefits and authorizations.

Prioritizes assigned claims according to regulatory timelines.

Requests additional information for incomplete or unclean claims; follows up with provider as necessary.

Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes.

Corresponds with IPAs/Medical Groups regarding misdirected claims.

Requirements:

2-5 years medical claims examining experience,

Minimum typing speed of 45 WPM and use of Ten-Key by touch

Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus

Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements

If you are interested, PLEASE CONTACT Tyler AT 407-478-0332 EXT 117

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