What are the responsibilities and job description for the Claims Examiner position at BizTek People, Inc. | APA International Placement Consultants?
POSITION SUMMARY:
Contract role. Contract to hire potential for the right candidate! The claims examiner reports directly to the claims manager.
They are primarily responsible for the processing functions (operation,
adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from
PHP affiliated medical groups and hospitals for HMO patients.
EDUCATION/EXPERIENCE/TRAINING:
• High school graduate or equivalent required
• Minimum of 2 years claims ADJUDICATION related experience
in ambulatory, acute care hospital, HMO, or IPA environment
• Knowledge of payment methodologies for: Professional (MD),
Hospital, Skilled Nursing Facilities, and Ancillary Services
* Knowledge and understanding of timeliness and payment
accuracy guidelines for commercial, senior and Medi-Cal claims
* Knowledge of compliance issues as they relate to claims
processing
• Experience in interpreting provider contract reimbursement
terms desirable
• Ability to identify non-contracted providers for Letter of
Agreement consideration
• Data entry experience
• Training on basic office automation and managed care
computer systems