US Tech Solutions
Claims Specialist
Location:
Whittier, CA 90601 Duration:
13 Weeks Contract Shift:
Monday - Friday, 07:00 am - 03:30 pm Must Have Skills: Claims reimbursement experience DOFR Experience processing lab claims
Position Summary: The claims examiner reports directly to the claims manager. They are responsible for processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims received from PHP affiliated medical groups and hospitals for HMO patients. Education / Experience / Training: High school diploma or equivalent; must have proof if background check cannot verify education. At least 2 years of claims adjudication experience in ambulatory, acute care hospital, HMO, or IPA environments. Knowledge of payment methodologies for professional (MD), hospital, skilled nursing facilities, and ancillary services. Understanding of timeliness and payment accuracy guidelines for commercial, senior, and Medi-Cal claims. Knowledge of claims processing compliance issues. Experience interpreting provider contract reimbursement terms is desirable. Ability to identify non-contracted providers for Letter of Agreement consideration. Data entry experience. Training in basic office automation and managed care computer systems.
Recruiter Details: Vishakha Singh Sr IT Recruiter E-mail: vishakha.singh@ustechsolutionsinc.com Internal ID: 25-43050 About US Tech Solutions: US Tech Solutions is a global staffing firm providing talent on-demand and workforce solutions. For more information, please visit our website. US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. #J-18808-Ljbffr
Whittier, CA 90601 Duration:
13 Weeks Contract Shift:
Monday - Friday, 07:00 am - 03:30 pm Must Have Skills: Claims reimbursement experience DOFR Experience processing lab claims
Position Summary: The claims examiner reports directly to the claims manager. They are responsible for processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims received from PHP affiliated medical groups and hospitals for HMO patients. Education / Experience / Training: High school diploma or equivalent; must have proof if background check cannot verify education. At least 2 years of claims adjudication experience in ambulatory, acute care hospital, HMO, or IPA environments. Knowledge of payment methodologies for professional (MD), hospital, skilled nursing facilities, and ancillary services. Understanding of timeliness and payment accuracy guidelines for commercial, senior, and Medi-Cal claims. Knowledge of claims processing compliance issues. Experience interpreting provider contract reimbursement terms is desirable. Ability to identify non-contracted providers for Letter of Agreement consideration. Data entry experience. Training in basic office automation and managed care computer systems.
Recruiter Details: Vishakha Singh Sr IT Recruiter E-mail: vishakha.singh@ustechsolutionsinc.com Internal ID: 25-43050 About US Tech Solutions: US Tech Solutions is a global staffing firm providing talent on-demand and workforce solutions. For more information, please visit our website. US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. #J-18808-Ljbffr