Medicare Claims Examiner

CenCal Health • Santa Barbara, CA

2d • $23 - $32 • Onsite

About The Position

This position is responsible for: researching, correcting and responding to all D-SNP pended claims as well the review of Audit reports in a timely manner; determining whether a claim should be paid (in accordance with the policies and procedures) and maintaining correspondence for document procedure /medical/CPT/ HCFA codes; assuring all regulatory guidelines are being followed.

Requirements

• QNXT experience
• Strong knowledge of the D-SNP program
• Strong knowledge in dual eligible claims processing (Medi-Cal and Medicare D-SNP )
• Prior experience in high volume production environment
• Good oral and written communication skills
• Attention to detail
• High school diploma or equivalent
• Three (3) years’ experience as a Claims Examiner

Nice To Haves

• Medical terminology and/or coding experience is highly desirable

Responsibilities

• Review, price and release claims associated with the assigned claim types (paper and electronic)
• Review Manual Review reports that suspend for review for D-SNP claims
• Keep up to date on all D-SNP policies and provide materials for improvement projects within Department
• Assure all regulatory guidelines are being followed and monitored
• Maintain daily activity log
• Assist with the processing of claims
• Other duties and projects assigned

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 251-500 employees