Senior Claims Examiner, FT Days

Pih Health Physicians • Pico Rivera, CA

101d • $21 - $33

About The Position

The Senior Claims Examiner administers health plan contracts by processing medical claims in an efficient, cost-effective, and timely manner meeting all required guidelines and performs adjustments as necessary. Some of the duties include handling of Third-Party Liability requests, Out-of-pocket Maximum requests, EDI rejects and other special projects. PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.

Requirements

• High school diploma or General Education Development.
• Minimum two (2) years medical claims processing experience.
• Computer and 10-key skills by touch.
• Knowledge of medical terminology, CPT/RBRVS/ICD-9 codes.
• Full understanding of HMO & capitation concepts and Medicare guidelines.
• Excellent communication skills.
• Ability to work independently and function under time deadlines.

Responsibilities

• Administer health plan contracts by processing medical claims.
• Handle Third-Party Liability requests.
• Process Out-of-pocket Maximum requests.
• Address EDI rejects.
• Work on other special projects as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED