Claims Examiner
at Engage Partners, Inc.

Date Posted: 5/7/2019

Job Description


We're seeking a Claims Examiner for a contract opportunity located in southern CA.  There's a chance this position can go contract-hire.  Seeking local candidates.
 

JOB SUMMARY:

The Claims Examiner is responsible for accurately and consistently adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy.  Processes claims according to guidelines.  Investigate and complete open or pended claims.  Meet production and quality standards.
 

ESSENTIAL JOB DUTIES:

         Meets productivity standards for number claims completed and for accuracy of entries

         Handles in a professional and confidential manner all correspondence

         Supports core values, policies, and procedures

         Receives, and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.

         Receives daily workflow via reports or work queue and incoming phone calls

         Researches claims for appropriate support documents

         Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied

         Responds and documents resolution of inquiries from internal departments

         Assists Finance with researching provider information to resolve outstanding or stale dated check issues

         Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases

 

KNOWLEDGE, SKILLS AND

Job Requirements



3+ years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting.  Knowledge of general claims processing principles.  Knowledge of CMS and UB coding.    Experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims.  Experience on an automated claims processing system (Epic Tapestry preferred)
 

Other Qualifications:
  • Education: High school diploma required
  • Ability to interpret Health Plans Division of Financial Responsibility for both IPA and Hospital Risk.  Knowledge of medical terminology, CPT, HCPCS, Revenue Codes and ICD-10 codes. Working knowledge of coordination of benefits and Correct Coding Initiative edits.  Knowledge and understanding of federal and state statutes, laws, rules and regulations.
  • Flexible and detail oriented 
  • Excellent verbal and written communication skills in the English language required

WORKING ENVIRONMENT:
  • Office-based
  • Must work well with other employees
  • Must be able to perform critical work under deadlines
  • Ability to work in a changing environment and handle multiple tasks

ORGANIZATIONAL EXPECTATIONS:

     Demonstrates behavior which supports the mission of the facility.  Attends required orientation and training seminars.  Work product and performance meets quality standards.  Demonstrates respect and positive interpersonal skills with co-workers.  Is a team player.  Maintains confidentiality of business matters.  Observes time, attendance, and dress code standards.  Follows policies, fire, safety and regulation rules.

 

Please send resumes to [Click Here To Join]

 

#CB
 

 

Job Snapshot

  • Employee Type: Full-Time
  • Location: Los Angeles, CA
  • Job Type: Insurance
  • Experience: Not Specified
  • Date Posted: 5/7/2019

About Us

Join a winning team that gets the job done right. At Engage Partners, Inc., we focus on excellence in the industry of staffing solutions. We work hard every day to get it right and get it done – the right employees, the right businesses, the right time.

There’s a reason why we have been around for decades. Engage Partners, Inc. has a wealth of experience matching people to their prospective employers (and vice versa). We have the ability to provide the opportunity for long-term career paths or temporary project assignments, temporary or full-time positions, executive management recruitment or attracting seasonal assistance. We work with a strong, diverse network of organizations across the country that are always looking for top-notch candidates to fill their open positions. From small business start-ups to Fortune 100 companies, we want your next job to be the one you’ve been waiting for.

We are a full-service staffing agency with opportunities for employment all across the U.S. Our recruitment efforts are focused on professionals in many areas of expertise:

  • Healthcare IT
  • Healthcare / Clinical & Non-Clinical
  • Administrative & Office Professionals
  • Information Technology
  • Sales & Marketing
  • Finance & Accounting
  • Pharmacy
  • Engineering, Energy & Green Technologies

Come see why our clients and our candidates seek out the level of service that makes the Engage Difference: We speak with our clients, not to them. Authoritative and approachable, it's always about the dialogue. Direct and to the point. Let's create solutions, not additional work.

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