Claims Examiner I
About The Position
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview A Claims Examiner is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Collaborates with other departments and/or providers in the successful resolution of claims-related issues.
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.
- Must have an understanding of how to read a CMS-1500 and UB-04 form.
- Must have strong organizational and mathematical skills.
- Must be able to multi-task
Nice To Haves
- Preferred knowledge of Medicare and Commercial rules and regulations.
Responsibilities
- Analyzing and adjudication of medical claims as it relates to managed care.
- Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes.
- Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries.
- Identifies root causes of claims payment errors and reports to Management.
- Responds to provider inquiries/calls related to claims payments.
- Collaborates with other departments and/or providers in the successful resolution of claims-related issues.
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Ambulatory Health Care Services
Education Level
High school or GED
Number of Employees
1,001-5,000 employees
