Non-Clinical FinanceAccounting Claims Examiner at vTech Solution

Job Summary: The Claims Examiner is responsible for processing UB-92 and HCFA-1500 claims from affiliated medical groups and hospitals for HMO patients. This includes operation adjudication and payment functions reporting directly to the claims manager. Location:Whittier California United States Responsibilities: - Process UB-92 and HCFA-1500 claims. - Perform claims adjudication and payment. - Identify non-contracted providers for Letter of Agreement consideration. - Data entry. - Interpret provider contract reimbursement terms. - Maintain knowledge of compliance issues related to claims processing. - Understand timeliness and payment accuracy guidelines for commercial senior and Medi-Cal claims. Required Skills & Certifications: - High school diploma or GED equivalent. - Minimum 2 years of claims adjudication experience in ambulatory acute care hospital HMO or IPA environment. - Knowledge of payment methodologies for Professional (MD) Hospital Skilled Nursing Facilities and Ancillary Services. - Claims reimbursement experience. - DOFR (Date of First Receipt) experience. - Experience processing lab claims. Preferred Skills & Certifications: - Experience interpreting provider contract reimbursement terms. Special Considerations: - Onsite interview required. - RTO (Requested Time Off) must be submitted at the time of submittal. Scheduling: - Monday - Friday - 07:00am - 03:30pm - Orientation time may differ from shift times listed. - Duration: 13 weeks Key Skills Auditing,GAAP,Military Experience,Phlebotomy,Conflict Management,Vital Signs Experience,Computer Forensics,Research Experience,Securities Law,Operating Systems,PTSD Care,RMF Employment Type : Full Time Experience: years Vacancy: 1