Claims Examiner

Healthcare Support Staffing; San Fernando (CA); On-site; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare staffing firm in San Fernando, CA is seeking an experienced Claims Examiner to join their team. This role requires 1-3 years of experience in processing managed care health claims, with responsibilities including analyzing claims, reviewing authorizations, and ensuring accurate data entry. If you have an understanding of health & managed care concepts and strong knowledge of coding schemes, this opportunity is for you. Join a prestigious company and advance your career in the healthcare industry.

Qualifications

• 1-3+ years of experience processing managed care health claims.
• Ability to type 40-45 wpm.
• Excellent understanding of health & managed care concepts.

Responsibilities

• Analyze professional & hospital claims for accuracy according to set standards.
• Review authorization & adjudicate claims accordingly.
• Accurate input of data for claims adjudication.

Skills

Managed Care claims experience

Understanding of health & managed care concepts

Knowledge of ICD9 CM, CPT, HCPCS coding

Medical terminology

Job description

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 407-478-0332 ext. 115 and/or click the Green I’m Interested Button to email your resume