Examiner – I Claims
| Company | AltaMed Health Services |
|---|---|
| Location | Montebello, CA, USA |
| Salary | $24 – $28.15 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Entry Level/New Grad, Junior |
Requirements
- HS Diploma or GED.
- Must have some knowledge of Medi-Cal regulations.
- Must have some Knowledge of medical terminology.
- Must understand to read and interpret DOFRs and Contracts.
- Preferred knowledge of Medicare and Commercial rules and regulations.
- Must have an understanding how to read a CMS-1500 and UB-04 form.
- Must have strong organizational and mathematical skills.
- Must be able to multi-task
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 payments.
- Collaborating with other departments and/or providers in successful resolution of claims related issues.
Preferred Qualifications
- Preferred knowledge of Medicare and Commercial rules and regulations.