JOB TITLE: Claims Examiner - Days LOCATION: 9557 Greenleaf Avenue, Whittier, CA SHIFT: Monday - Friday - 07:00am - 03:30pm DURATION - 13 weeks 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER EDUCATION POSITION SUMMARY: 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. Must have physical proof on hand if background check is unable to verify your education background.
• 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 RTO MUST BE SUBMITTED AT TIME OF SUBMITTAL, NO EXCEPTIONS

Shifts: Day (5x8 Hours) 7:00 15:30

Job Priority: MSP

Facility: Non-Clinical - PIH Health Physicians

Location: Whittier , CA , 90601