Pacer Group
Claims Examiner
Location: Whittier, CA
Specialty: Non-Clinical - Finance/Accounting
Shift: Day (5 x 8 Hours) 07:00 - 15:30
Positions: 5
Duration: 13 weeks
Key Requirements
Experience:
Minimum 2 years of claims adjudication in ambulatory, acute care hospital, HMO, or IPA environment. Education:
High school diploma or GED (physical proof required if verification fails). Mandatory: Must have claims reimbursement experience DOFR (Division of Financial Responsibility) experience required Must have processed lab claims References:
Will need professional references for submission. Interview:
Onsite interview required. Position Summary The Claims Examiner reports directly to the Claims Manager and is responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims received from PHP affiliated medical groups and hospitals for HMO patients. Skills & Knowledge Knowledge of payment methodologies for: Professional (MD) Hospital Skilled Nursing Facilities Ancillary Services Understanding of timeliness and payment accuracy guidelines for commercial, senior, and Medi-Cal claims. Knowledge of compliance issues related to claims processing. Ability to interpret provider contract reimbursement terms. Ability to identify non-contracted providers for Letter of Agreement consideration. Data entry skills and experience with office automation and managed care computer systems. Additional Information RTO: Must be submitted at time of submittal - no exceptions. Orientation: Orientation time may differ from shift hours listed.
Minimum 2 years of claims adjudication in ambulatory, acute care hospital, HMO, or IPA environment. Education:
High school diploma or GED (physical proof required if verification fails). Mandatory: Must have claims reimbursement experience DOFR (Division of Financial Responsibility) experience required Must have processed lab claims References:
Will need professional references for submission. Interview:
Onsite interview required. Position Summary The Claims Examiner reports directly to the Claims Manager and is responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims received from PHP affiliated medical groups and hospitals for HMO patients. Skills & Knowledge Knowledge of payment methodologies for: Professional (MD) Hospital Skilled Nursing Facilities Ancillary Services Understanding of timeliness and payment accuracy guidelines for commercial, senior, and Medi-Cal claims. Knowledge of compliance issues related to claims processing. Ability to interpret provider contract reimbursement terms. Ability to identify non-contracted providers for Letter of Agreement consideration. Data entry skills and experience with office automation and managed care computer systems. Additional Information RTO: Must be submitted at time of submittal - no exceptions. Orientation: Orientation time may differ from shift hours listed.