Robert Half Accountemps Medical Claims Examiner in Encino, California
A well know Medical Network is in need of a Medical Claims Examiner for their location in Encino. As the Medical Claims Examiner you will be responsible for accurately and consistently adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy. Processes claims according to all CMS and DMHC guidelines. Investigate and complete open or pended claims. Meet production and quality standards.
ESSENTIAL JOB DUTIES:
Meets productivity standards for number claims completed and for accuracy of entries Handles in a detail oriented and confidential manner all correspondence Receives, and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information. Receives daily workflow via reports or work queue and incoming phone calls Researches claims for appropriate support documents Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied Responds and documents resolution of inquiries from internal departments Assists Finance with researching provider information to resolve outstanding or stale dated check issues Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases
KNOWLEDGE, SKILLS AND EXPERIENCE: 3+ years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting. Knowledge of general claims processing principles. Knowledge of CMS and UB coding. Experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims. Experience on an automated claims processing system (Epic Tapestry preferred)
If you are interested please submit your resume to: firstname.lastname@example.org
Accountemps matches highly skilled professionals with accounting finance jobs at the best companies on a temporary and temporary-to-hire basis. Our mission is to provide you with a rewarding finance or accounting job that is well matched to your professional skills helping you to advance in your career. Our experience, combined with the resources of our worldwide network of offices, makes Accountemps a great resource for your career. We offer excellent opportunities to find temporary accounting and finance jobs for all experience levels. From accounting clerks and bookkeepers to accounts payable and staff accountants, we can provide you unparalleled access to exciting career opportunities. But don't take our word for it. Our company has appeared on Fortune® magazine's list of "World's Most Admired Companies" since 1998, and 9 out of 10 of our customers would recommend our service to a colleague.
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