Claims Examiner Job at Pacer Group, Whittier, CA

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  • Pacer Group
  • Whittier, CA

Job Description

Claims Examiner

Location: Whittier, CA

Specialty: Non-Clinical – Finance/Accounting

Shift: Day (5 x 8 Hours) 07:00 – 15:30

Positions: 5

Duration: 13 weeks

Key Requirements

  • Experience: Minimum 2 years of claims adjudication in ambulatory, acute care hospital, HMO, or IPA environment.
  • Education: High school diploma or GED (physical proof required if verification fails).

Mandatory:

  • Must have claims reimbursement experience
  • DOFR (Division of Financial Responsibility) experience required
  • Must have processed lab claims

References: Will need professional references for submission.

Interview: Onsite interview required.

Position Summary

  • The Claims Examiner reports directly to the Claims Manager and is responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims received from PHP affiliated medical groups and hospitals for HMO patients.

Skills & Knowledge

  • Knowledge of payment methodologies for:
  • Professional (MD)
  • Hospital
  • Skilled Nursing Facilities
  • Ancillary Services
  • Understanding of timeliness and payment accuracy guidelines for commercial, senior, and Medi-Cal claims.
  • Knowledge of compliance issues related to claims processing.
  • Ability to interpret provider contract reimbursement terms.
  • Ability to identify non-contracted providers for Letter of Agreement consideration.
  • Data entry skills and experience with office automation and managed care computer systems.

Additional Information

  • RTO: Must be submitted at time of submittal – no exceptions.
  • Orientation: Orientation time may differ from shift hours listed.

Job Tags

Contract work, Work at office, Shift work,

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