7 Jobs in Carson, CA
MemorialCare is Hiring a Claims Examiner II Near Carson, CA
Location: Fountain Valley
Department: Claims
Status: Full-Time
Shift: Days (8hrs)
Pay Range: $22.41/hr - $32.50/hr
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Position SummaryThe Claims Examiner II accurately reviews, researches and analyzes professional, ancillary and institutional inpatient and outpatient claims.
Essential Functions And Responsibilities Of The Job
- Knowledge of CPT/HCPC and ICD-9/ICD-10 codes and guidelines.
- Comprehensive knowledge of DMHC and CMS guidelines to accurately adjudicate Commercial and Medicare Advantage claims.
- Comprehensive knowledge of various fee schedules and CMS prices for outpatient/inpatient institutional, ancillary and professional claims, including, but not limited to Medicare fee schedules, DRG, APC, ASC, SNF-RUG.
- Ability to identify and report processing inaccuracies that are related to system configuration.
- Process all types of claims, such as, HCFA 1500, outpatient/inpatient UB92, high dollar claims, COB and DRG claim.
- Reviews. processes and adjudicate claims for payment accuracy or denial of payment according to Department's policy and procedures.
- Processes all claims accurately conforming to quality and production standards and specifications in a timely manner.
- Documents resolution of claims to support claim payment and/or decision.
- Makes benefit determinations and calculations of type and level of benefits based on established criteria and provider contracts.
- Understands and interprets health plan Division of Financial Responsibilities and contract verbiage.
- Determines out-of-network and out-of-area services providers and processes in accordance with company and governmental guidelines.
- Adjudication of Commercial and Medicare Advantage claims.
- Ability to prioritize, multitask and manage claims assignment within department goals and regulatory compliance and with minimal supervision.
- Ability to make phone calls to Provider/Billing offices when necessary, based on department guidelines.
- Requests additional information or follow up with provider for incomplete or unclean claims.
- Ability to effectively communicate with External and Internal teams to resolve claims issues.
- Ability to interact in a positive and constructive manner.
- Minimum of 5 years' experience in processing all types of professional, ancillary, and institutional claims in Managed Care.
- Comprehensive knowledge of various fee schedules and CMS prices for professional, facility and ancillary claims.
- Comprehensive knowledge of CPT, ICD-9 and ICD-10 codes, inpatient procedure coding, HCPCS, Revenue Codes, medical terminology and COB required.
- Working knowledge of Claims Information systems.
- Understands division of financial responsibility for determination of financial risk.
- Type a minimum of 45 words per minute.
Job Summary
Full Time
Hospital
$72k-93k (estimate)
05/31/2024
06/22/2024
memorialcare.org
LONG BEACH, CA
3,000 - 7,500
2005
NGO/NPO/NFP/Organization/Association
LISA FORSYTHE
$1B - $3B
Hospital
Related Companies
About MemorialCare
MemorialCare owns and operates a chain of hospitals that provides pediatrics and surgical services.
The job skills required for Claims Examiner II include Billing, CPT, Knowledge of Claims, Communicates Effectively, etc. Having related job skills and expertise will give you an advantage when applying to be a Claims Examiner II. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Claims Examiner II. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Claims Examiner II positions, which can be used as a reference in future career path planning. As a Claims Examiner II, it can be promoted into senior positions as a Claims Examiner III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Examiner II. You can explore the career advancement for a Claims Examiner II below and select your interested title to get hiring information.
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