1 Claims Appeals Examiner Job in West Sacramento, CA
TalentoHCM is Hiring a Claims Appeals Examiner Near West Sacramento, CA
Claims Appeals Examiner
TalentoHCM is partnered with a $1b revenue organization with 10,000 employees that provides public sector technology and back-office solutions enabling $800b in healthcare spend. They are looking to add a Claims Appeals Examiner to their organization for a long-term assignment.
- Examine returns and payments from multiple business entities to determine and make appropriate adjustments, such as approving or denying refunds and claims
- Analyze and review claims based on claim types: long term care, inpatient, outpatient, or medical using CA-MMIS program
- Calculate provider rate based on the provider rate master file and process adjustments as needed
- Complete Claim Inquiry Forms to process provider appeals or claims
- Respond to providers in written form by entering appropriate paragraph codes into the appeals sub-system and/or creating text to clarify the response
- Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation
- Maintain performance within defined qualitative and quantitative objectives
- Review and resolve provider appeal within provider manual guidelines
- Provide clerical support to management as needed
- Ability to research the Provider Manual and policy set by the Department of Health Care Services
- Verify recipient eligibility and benefits, revenue, and ICD-9 codes
- Ensure timeliness guidelines are met by reviewing the provider documentation
- Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the job
- Specific level of software skills as required by the work unit
- Must have excellent problem-solving skills
- Good verbal and written communication skills
- High school education or equivalent
- 1-3 years’ experience preferred
- Must be a proficient typist and have a minimum of 50 WPM while maintaining a 99.9% accuracy
Talento Human Capital Management is an equal opportunity employer people are at the center of what we do! Our organization continues to thrive through our ongoing commitment to building an inclusive and diverse workforce from different backgrounds and perspectives.
People Passion Perseverance = Progress.
About Talento:
Talento Human Capital Management provides talent and organizational solutions enabling businesses to evolve beyond tactical human resources management. Our footprint spans across the US Latin America and Asia.
Job Summary
Full Time
$41k-51k (estimate)
07/07/2023
06/08/2024
talentohcm.com
Miami, FL
<25
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