Job Details |
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| Claims Examiner - Remote | |
| Job ID: | 00004HLW |
| Category: | MedicalDental |
| Location: | CA Santa Barbara |
| Hours: | 40 Monday to Friday 8am to 5pm |
| Pay: | $21.00 $21.00 |
| Great Opportunity Available in Santa Barbara | |
| Job Description Under the direct supervision of the Claims Supervisor, this position is responsible for researching, correcting and responding to all pended claims as well the review of Audit reports in a timely manner, determining whether a claim should be paid in accordance with the policies and procedures and maintaining correspondence for document procedure medicalCPT HCFA codes and assuring all regulatory guidelines are being followed. Review, price and release claims associated with the assigned claim types paper and electronic. Review Manual Review reports that suspend for review on all programs. Review audit reports for all Health programs. Analyze current processes and work with Supervisor to automate or improve quality where fit. Assist with ideas for creation of SCF System Change Forms when applicable. Keep up to date on all policies and provide materials for improvement projects within Department. Assure all regulatory guidelines are being followed and monitored. Maintain daily activity log. Assist with the processing of claims. Audit and report all billing error trends found during the course of review and data entry. Maintain processes and timelines required by AB1455 Claims Settlement Practices and DHCS Regulations. Other duties and projects as assigned. | |
| Skills Required HS Diploma or GED. Exp as a Claims Examiner. Knowledge of Medi-Cal program. Exp handling a high volume of claims. Good communication skills. Proficient in MS Office. | |
| Skills Preferred Exp in insurance, billing, working in a providers office, registration, verifying eligibility, collecting co insurance, claims processing a plus. Medical terminology andor coding exp. BA Degree in business or similar. Coding classes a plus. | |