Claims Adjudicator - Growth-Minded Organization

Large Healthcare Group is looking for an experienced Claims Adjudicator to work onsite in Whittier, CA. Must have at least 2 years experience in healthcare claims adjudication.

Schedule: M-F, 7 am to 3:30 PM

3 Month Contract- Possibility of Extension

Location: Whittier, CA

Start Date: ASAP

Pay Rate: $25 to $26 an Hour

POSITION SUMMARY:

The claims examiner reports directly to the claims manager. They are primarily responsible for the processing functions (operation, adjudication, and payment)of UB-92 and HCFA-1500 claims that are received from affiliated medical groups and hospitals for HMO patients.

EDUCATION/EXPERIENCE/TRAINING:

• Minimum of 2 years claims ADJUDICATION related experience in ambulatory, acute care hospital, HMO, or IPA environment
• Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
• Knowledge and understanding of timeliness and payment accuracy guidelines for commercial, and Medi-Cal claims
• Knowledge of compliance issues as they relate to claims processing
• Experience in interpreting provider contract reimbursement terms desirable
• Ability to identify non-contracted providers for Letter of Agreement consideration
• Data entry experience
• Training on basic office automation and managed care computer systems

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The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.