Medical Claims Examiner Needed II Needed

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POST DATE 9/12/2016
END DATE 10/24/2016

ACT-1 Los Angeles, CA

Los Angeles, CA
AJE Ref #
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Full Time
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Well-known company has an immediate need for a Medical Claims Examiner with at least 3 years of DIRECT health care claims processing experience in a managed care environment/health care setting.

**Bilingual Spanish a plus**

Accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines. Processing claims for all lines of business, including complex claims. Monitoring itemized billings for excessive charges, duplications, unbundling, and medical coding. Determining prior authorization/precertification of services paid via system and/or health services. Requesting and reviewing medical records as needed for basic information to validate billing information. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Ability to operate PC-based software programs or automated database management systems.

Prior experience as an Medical Claims Examiner in a health care setting. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-9, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge. Moderate knowledge of Microsoft Word and Excel. Previous Medi-Cal claims processing experience, knowledge of State Department of Health Services regulations, and previous experience in EDI Claims processing a plus.

**Bilingual Spanish a plus**

Apply for this great position as a Medical Claims Examiner today! Send resume as Microsoft Word attachment to Azuri Ross for immediate consideration. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.