Claims Examiner

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 required 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 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 Additional Information Interested in being considered? If you are interested in applying to this position, please contact Blake Anderson at View phone number on click.appcast.io ext. 115 and/or click the Green I’m Interested Button to email your resume #J-18808-Ljbffr HealthCare Support