Claims Examiner II: Medical Claims Adjudication

Universal Healthcare IPA, Inc.; Bakersfield (CA); In loco; USD 29.000 - 37.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental insurance

Vision insurance

PTO

Floating holidays

Simple IRA 3% match

Life insurance

Employee assistance program

Descrizione del lavoro

Universal Healthcare IPA, Inc. in Bakersfield, CA seeks a Claims Examiner II to adjudicate medical claims (CMS 1500 and CMS 1450/UB04) in our claims system.

This full-time, non-exempt, hourly role requires accurate data entry, knowledge of CPT/HCPCS/ICD-10, and adherence to contracts and paid-time policies. The position emphasizes independent work, timely processing, and collaboration with Eligibility, Member Services, UM, providers, and health plans.

Competenze

• High School diploma or equivalent.
• Strong knowledge of professional and institutional claim processing procedures.
• Familiarity with CPT, HCPCS, ICD-10, ASA, Revenue Codes.
• Proficiency in MS Excel, Word, and Outlook.
• Ability to type 40-50 Words per minute (WPM).
• One or more years working in a healthcare or related business environment preferred.

Mansioni

• Review and process claims following policies and criteria.
• Evaluate payments based on eligibility, benefits, authorizations, coding, and contracts.
• Apply correct terms to claims per contracts and health plan rules.
• Process denials accurately and generate denial letters.
• Meet timeliness and quality standards in claim processing.
• Make payment or denial decisions while handling confidential information.
• Refer misaligned claims to the UM department.
• Coordinate with Eligibility, Member Services, UM, providers and health plans.
• Work independently following established policies and procedures.

Formazione

High School diploma

Strumenti

CMS 1500

CMS 1450/UB04

Billing system

Descrizione del lavoro

Universal Healthcare IPA, Inc. in Bakersfield, CA seeks a Claims Examiner II to adjudicate medical claims (CMS 1500 and CMS 1450/UB04) in our claims system.

This full-time, non-exempt, hourly role requires accurate data entry, knowledge of CPT/HCPCS/ICD-10, and adherence to contracts and paid-time policies. The position emphasizes independent work, timely processing, and collaboration with Eligibility, Member Services, UM, providers, and health plans.