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Claims Examiner - Contract

Location: Brea, California, United States
Job # 11417855
Date Posted: 09-26-2018
Title: Claims Examiner
Location: Brea, CA 92821
Salary: Up to $20.00 per hour

The Claims Examiner is responsible to process and review manual and electronic claims for accuracy, completeness and eligibility.  Reviews Medical Records and or reports submitted by Providers for appeals and/or for payment reconsideration to ensure proper coding and correct claims adjudication.
Essential Duties and Responsibilities
  • Data Entry: Enter paper claims and work electronic claims
  • Adjudication: determines proper payment of Radiation claims
  • Customer Service: Makes and receives provider calls regarding potential claims issues/escalations
  • Coordinates and maintain flow of documents between team members and Providers to ensure accurate, timely and effective communication.
  • Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees.
  • Professionally and effectively communicates with external payer representatives (commercial and government) regarding, but not limited to, claims issues including trouble shooting, root cause analysis, disputes and resolution. 
  • Reviews claims to ensure that billing requirements are met, updates accounts as necessary and answers inquiries regarding claim status.
  • Reviews medical records/charts/notes/reports from all specialties including but not limited to Oncology and Cardiology.
  • Trends claims issues by Billing Code, Denial Codes and/or Provider related contract.
  • Performs other duties as assigned.
Skills / Requirements
  • Bachelor’s degree in a related field preferred.  
  • Claims experience within cardiology and/or oncology preferred
  • Managed care experience
  • Strong working knowledge of health programs including commercial insurance and government health programs. 
  • Proven ability to successfully manage multiple projects with conflicting priorities and timelines.
  • Strong research and analytical skills; able to independently research information and present sound analytical findings
  • Strong communication skills both written and oral.
  • Ability to communicate effectively and professionally with both internal members of the organization and external partners.
  • Detail-oriented; strong organization and project management skills including stellar follow up skills
  • Professional presentation skills; able to present complex information that is clear, concise and accurate
  • Strong working knowledge of MS Office products (Excel, Word, Power Point, Project and Visio)
  • Effective communication skills that build and foster strong, positive working relationships across multiple departments
  • Self-directed, demonstrated ability to take initiative
  • Fast typing speed and experience with 10 key.
  • Oncology experience highly preferred
  Please submit your resume for immediate consideration. Thank you!
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