Growing and Expanding Healthcare Company in Downtown Los Angeles looking to hire a Medical Claims Examiner with at least 3 years of DIRECT health care claims processing experience in a managed care environment and/or health care setting.
Accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines. Processing claims for all lines of business, including complex claims. Monitoring itemized billings for excessive charges, duplications, unbundling, and medical coding. Determining prior authorization/precertification of services paid via system and/or health services. Requesting and reviewing medical records as needed for basic information to validate billing information. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated.
Experience working with PDR's, strong background in analyzing healthcare data and identifying problem areas and opportunities for improvement; must have sound understanding of health care code sets including CPT, HCPCS, ICD-9 and revenue codes. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts and complete product and Coordination Of Benefits (COB) knowledge. Microsoft Word and Excel. Previous Medi-Cal claims processing, knowledge of State Department of Health Services regulations and previous experience in EDI Claims processing a plus.
•*Please note: Company does not cover parking, best options to utilize are Commuter Bus, Train, Metro or Driving and utilizing parking lots/garages in DTLA**
Apply for this great position as a Medical Claims Examiner today! Send resume as Microsoft Word attachment to Azuri Ross for immediate consideration. We are an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, age (40 and over), gender identity, national origin, protected veteran status, disability or any other protected classification under federal and state law.