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Claims Examiner II
| Company | AltaMed Health Services |
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| Location | Montebello, CA, USA |
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| Salary | $26.13 – $32.55 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Mid Level |
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Requirements
- HS Diploma or GED
- Minimum of 3 years of Claims Processing experience in a managed care environment.
- Experience in reading and interpreting DOFRs and Contracts, required.
- Experience in reading CMS-1500 and UB-04 forms required.
Responsibilities
- Analyzing and adjudicating medical claims as it relates to managed care.
- Performing payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes.
- Resolving claims payment issues as presented through Provider Dispute Resolution (PDR) process or from claims incident/inquiries.
- Identifying root causes of claims payment errors and reporting to Management.
- Responding to provider inquiries/calls related to claims payment.
- Collaborating with other departments and/or providers in successful resolution of claims related issues.
Preferred Qualifications
No preferred qualifications provided.
