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
Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.
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.
Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.
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.