MEDICAL CLAIMS EXAMINER NEEDED!
Location: Los Angeles
Posted on: November 7, 2024
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Job Description:
Medical Company has immediate opening for a Medical Claims
Examiner. You will be responsible for the accurate and timely
processing of direct contract and delegated claims per regulatory
and contractual guidelines. You will process claims for all lines
of business, including complex claims,
monitor itemized billings for excessive charges, duplication,
unbundling, and medical coding, determine prior
authorization/precertification of services paid via system and/or
health services, and review claims for required information,
pending claims when necessary, maintain a follow-up system, and
update and release pending claims when indicated. Looking for
someone with at least six years of years of healthcare claims
processing experience in a managed care environment and strong
experience in handling complicated claims cases. Extensive
knowledge of medical terminology, standard claims forms and
physician billing coding, ability to read/interpret contracts,
standard reference materials (PDR, CPT, ICD-9, and HCPCS), and
complete product and Coordination Of Benefits (COB) knowledge is
required.
Previous Medi-Cal claims processing experience and knowledge of
State Department of Health Services regulations is highly
preferred. Must have knowledge of Medicare claims processing.
Bilingual Spanish is a plus. Email resume as a word attachment to
Paris Goldfarb.
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected
veteran status.
Keywords: , Aliso Viejo , MEDICAL CLAIMS EXAMINER NEEDED!, PR / Public Relations , Los Angeles, California
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