Description

A Healthcare IPA in Long Beach is in the need of a Medical Claims Examiner III. This role of Medical Claims Examiner III will be an essential position within the organization. The Medical Claims Examiner III is responsible for collaborating with the team to meet productivity goals as well as ensure quality. The Medical Claims Examiner should possess claims knowledge, prioritizing skills, and the ability to multi-task. EZ CAP software is a must.

• Audit claims processing quality, develops, maintains and runs standard reports

• Assist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural)

• Coordinating with various departments to resolve disputes or issues

• Review and process hospital claims and complicated claims to assist claims examiners I, and II

• Claims processing to ensure quality (in/outpatient hospital claims, Medi-cal, Commercial, and Medi-care claims)

• Review auto adjudication of claims

• Review carve-outs in the Division of Financial Responsibility (DOFR)

• Review and process reports and work with management and claims unit

• Assist the Claims Manager in reviewing the quality auditing tracking/reporting

• Assist with training/supporting the claims team

• Recommend and assist in the development of process improvements

• Coordinating with various departments to resolve disputes or issues

• Able to process a claim and assist the team by answering questions and providing support

Requirements

Medical Claims, EZCAP

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