Non-Clinical - Finance/Accounting - Claims Examiner

Bestica

Whittier, CA

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JOB DETAILS

SKILLS

Accounting, Acute Care, Adjudication, Ambulatory Care, Automation, Centers for Medicare and Medicaid Services (CMS), Claims Management, Claims Processing, Computer Systems, Contract Analysis, Data Entry, Finance, Health Maintenance Organization (HMO), Higher Education, Hospital, Managed Care, Medi-Cal, Nursing, PHP Scripting Language (PHP Hypertext Preprocessor), Provider Contracting, Registered Training Organisation (RTO), Reimbursement

LOCATION

Whittier, CA

POSTED

4 days ago

Must have listed claims reimbursement experience Must have DOFR Must have processed lab claims * Will Need 3 Supervisor References to Submit. **ONSITE INTERVIEW REQUIRED** JOB TITLE: Claims Examiner Days LOCATION: 9557 Greenleaf Avenue, Whittier, CA SHIFT: Monday - Friday - 07:00am - 03:30pm PLEASE NOTE ORIENTATION TIME MAY DIFFER THAN SHIFT TIMES LISTED DURATION - 13 weeks *** 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION*** 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 PHP affiliated medical groups and hospitals for HMO patients. EDUCATION/EXPERIENCE/TRAINING: High school graduate or equivalent required. Must have physical proof on hand if background check is unable to verify your education background. 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, senior 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 RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONS

About the Company

Bestica

We are a trusted provider of solutions in Information Technology and Healthcare sectors to the DoD, Federal and Commercial markets. Our guiding principle and core values help us care for our people and the community; and build a culture of excellence which in turn helps us achieve our organizational objective of exceeding customer’s expectations in each and every project. Headquartered in San Antonio, TX, we were founded in 2005 and believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where innovation and synergy are encouraged to build our workplace into a community of like-minded, passionate people.

COMPANY SIZE

50 to 99 employees

INDUSTRY

Government and Military

FOUNDED

2005

WEBSITE

http://www.bestica.com/