Claims Examiner I
AltaMed Health Services is dedicated to providing exceptional care to the community. The Claims Examiner is responsible for analyzing and adjudicating medical claims, resolving payment issues, and collaborating with departments to address claims-related inquiries.
Responsibilities
- Analyzing and adjudication of medical claims as it relates to managed care
- Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes
- Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries
- Identifies root causes of claims payment errors and reports to Management
- Responds to provider inquiries/calls related to claims payments
- Collaborates with other departments and/or providers in the successful resolution of claims-related issues
Skills
- HS Diploma or GED
- Must have some knowledge of Medi-Cal regulations
- Must have some Knowledge of medical terminology
- Must understand to read and interpret DOFRs and Contracts
- Must have an understanding of how to read a CMS-1500 and UB-04 form
- Must have strong organizational and mathematical skills
- Must be able to multi-task
- Preferred knowledge of Medicare and Commercial rules and regulations
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
Company Overview
Company H1B Sponsorship
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