Claims Examiners

Healthcare Support Staffing; Los Angeles (CA); On-site; USD 45,000 - 65,000; Full time

Job summary

A national healthcare staffing firm in Los Angeles is seeking a Claims Examiner responsible for the accurate and timely adjudication of claims. The ideal candidate will have 1-3 years of experience in processing managed care claims, strong knowledge of medical terminology, and proficiency in Microsoft Office. The position offers a Monday-Friday schedule, starting as soon as HR clearance is complete. Qualified individuals will excel in a fast-paced environment, ensuring accuracy in coding and data entry.

Qualifications

• 1-3+ years of processing managed care health claims required.
• Strong knowledge of medical terminology is mandatory.
• Must demonstrate ability to type at least 40-45 wpm.

Responsibilities

• Responsible for the accurate and timely adjudication of all claims.
• Manage claims efficiently to meet daily production goals.
• Maintain 98 percent coding and financial accuracy.

Skills

Strong knowledge of medical terminology

Strong Ten Key by touch

Typing speed of 40-45 wpm

Proficient with Microsoft Office

Knowledge of ICD-9, CPT, HCPCS coding

Claims adjudication systems experience

Education

HS Diploma or GED

Tools

Microsoft Office

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Company Job Description/Day to Day Duties:

• Reports to the Director of Claims
• Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements
• Examiners are expected to produce a minimum of 30 claims per hour.
• Examiners are expected to maintain 98 percent coding and financial accuracy.
• Examiners must meet timeliness requirements for the product line(s) they are responsible for processing. This can be achieved by effectively managing pended items/claims on a daily basis (working them at least two times a day) and by meeting daily production goals.
• Timeliness:
  • Medicare: 30 calendar days regardless of provider contract status.
  • Medi-Cal: 30 calendar days regardless of provider contract status.
  • Commercial: 60 calendar days regardless of provider contract status.

Qualifications

Minimum Education/Licensures/Qualifications:

• HS/Diploma or GED/equivalent
• 1-3+ years of processing of managed care health claims
• Strong knowledge of medical terminology
• Strong Ten Key by touch
• Ability to type at least 40-45 wpm (if they are unsure of typing skills, please send prove it!)
• Proficient with Microsoft Office/General office equipment experience (i.e. photocopier, fax, calculator, ability to operate a PC)
• Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes
• Experience with different software and hardware systems for claims adjudication
• Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims.
• Must be able to accurately assess financial responsibility and liability for claims submitted by both members and providers.
• Accurate input of data is required for claims adjudication including: diagnostic and procedural coding, pricing schedules, member and provider identification, and all other related information as required.
• Best Candidate: 3+ years of experience working on Managed Care claims
• 2nd Best: 1+ year experience as a Claims Examiner

Additional Information

• Location: 15821 Ventura Blvd suite 600
• If Contract, Length of Assignment: RTH
• Shift: Monday-Friday, 8am-5pm (There is a night shift, but as of now they are not looking to fill any night spots- if you have a candidate seeking a later shift, I am happy to present them)
• Start Date: As soon as all HR is back and clear
• Times/Interviewer: Phone interviews with hiring manager- Laura Saez, Claims Supervisor- possible for same day scheduling if not as soon as next day