MEDICAL CLAIMS EXAMINER NEEDED!
Location: Los Angeles
Posted on: October 29, 2024
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Job Description:
Well known Health Care Organization has immediate opening for a
Medical Claims Examiner. You will be responsible for the accurate
and timely processing of direct contract and delegated claims per
regulatory and contractual guidelines. You will process claims for
all lines of business, including complex claims, monitor itemized
billings for excessive charges, duplication, unbundling, and
medical coding, determine prior authorization/precertification of
services paid via system and/or health services, and review claims
for required information, pending claims when necessary, maintain a
follow-up system, and update and release pending claims when
indicated. Looking for someone with at least six years of years of
health care claims processing experience in a managed care
environment and strong experience in handling complicated claims
cases. Extensive knowledge of medical terminology, standard claims
forms and physician billing coding, ability to read/interpret
contracts, standard reference materials (PDR, CPT, ICD-9, and
HCPCS), and complete product and Coordination Of Benefits (COB)
knowledge is required. Previous Medi-Cal claims processing
experience and knowledge of State Department of Health Services
regulations is highly preferred. Must have knowledge of Medicare
claims processing. Bilingual Spanish is a plus. Email resume as a
word attachment to Paris Goldfarb.
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected
veteran status.
Keywords: , Hawthorne , MEDICAL CLAIMS EXAMINER NEEDED!, Healthcare , Los Angeles, California
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