Senior Medi-Cal Claims Examiner

Partnership HealthPlan of California; Fairfield (AR); On-site; USD 65,000 - 79,000; Full time

Job summary

Partnership HealthPlan of California is seeking a Claims Examiner II to review, research, and resolve Medi-Cal claims within established production and quality standards. The role requires autonomy and experience to handle a wider range of claim types and to generate provider communications as needed.

You will route and track claims for review, adhere to Medi-Cal Provider Manual guidelines, and maintain daily production statistics.

Qualifications

• Effective written and oral communication skills.
• Good organization skills.
• Knowledge of claims processing and Medi-Cal billing, CPT, and ICD10 knowledge preferred.

Responsibilities

• Reviews, researches, and resolves pended Medi-Cal claims.
• Routes claims to appropriate departments for review and follows up until completion.
• Generates claims correspondence as needed.
• Records daily production statistics and logs.
• Assists in procedures to resolve all pended claim types.
• Performs other duties as assigned.

Skills

Communication skills

Organization

Medi-Cal billing knowledge

Claims processing

CPT/ICD-10 knowledge

Education

High school diploma

1 year Medi-Cal billing/claims experience

Job description

Partnership HealthPlan of California is seeking a Claims Examiner II to review, research, and resolve Medi-Cal claims within established production and quality standards. The role requires autonomy and experience to handle a wider range of claim types and to generate provider communications as needed.

You will route and track claims for review, adhere to Medi-Cal Provider Manual guidelines, and maintain daily production statistics.