Non-Clinical - Finance/Accounting/Claims Examiner # 26-06718
US Tech Solutions
Job Title
Job Description:
- Must have listed claims reimbursement experience
- Must have DOFR
- Must have processed lab claims
Responsibilities:
- The claims examiner reports directly to the claims manager.
- They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
- Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
- Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims
- Knowledge of compliance issues as they relate to claims processing
- Experience in interpreting provider contract reimbursement terms desirable
- Ability to identify non-contracted providers for Letter of Agreement consideration
Experience:
- Minimum of 2 years claims adjudication related experience in ambulatory, acute care hospital, HMO, or IPA environment
Skills:
- Data entry experience
- Training on basic office automation and managed care computer systems
Education:
- High School Diploma/GED
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement:
By applying, you acknowledge that AI-assisted tools may be used during hiring.
US Tech SolutionsVacancy posted 2 days ago
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